Department of Endocrinology and Diabetology, Hedi Chaker Univsersity Hospital, Sfax, Tunisia.
Department of Nuclear Medicine, Habib Bouguiba University Hospital, Sfax, Tunisia.
Front Endocrinol (Lausanne). 2022 Aug 24;13:999331. doi: 10.3389/fendo.2022.999331. eCollection 2022.
The incidence of differentiated thyroid cancer (DTC) has risen dramatically worldwide. Despite an excellent prognosis, the growing DTC survivors' community often features poor health-related quality of life (HRQoL), which challenges long-term DTC care, particularly in developing Southern Mediterranean and African countries. We aimed to assess the HRQoL and to investigate its determinants in disease-free Tunisian DTC survivors.
We conducted a three-month cross-sectional study that included 266 patients diagnosed with DTC. We assessed the HRQoL in eligible participants using the short form-36 health survey, in comparison with 76 healthy controls.
The 86 eligible DTC survivors were predominantly female (89.5%) with an average age of 44.3 ± 12.5 years. Physical-functioning (PF), role-physical (RP), and pain domains were substantially altered compared to the reference population. Age was negatively associated with PF, RP, role-emotional (RE), and social functioning (SF). Tumor size and lymph node metastases affected general health and PF, respectively. The cancer-free survival duration was positively correlated with mental health (MH). Poor neck scar healing and persistent post-operative hypoparathyroidism significantly deteriorate MH. Pain perception was positively correlated with the radioactive iodine cumulative dose. Subclinical hyperthyroidism significantly reduced PF and RP scores. TSH suppression was negatively and strongly correlated with MH and SF scores.
HRQoL is substantially reduced in DTC survivors compared to the normative Tunisian population. These results could be extrapolated to similar individuals in other South Mediterranean and African countries. The development of coordinated multidisciplinary aftercare interventions in this region is warranted to preserve HRQoL in DTC survivors.
世界各地分化型甲状腺癌（DTC）的发病率显著上升。尽管预后良好，但不断增加的 DTC 幸存者群体通常存在较差的健康相关生活质量（HRQoL），这对长期的 DTC 护理提出了挑战，尤其是在发展中的南地中海和非洲国家。我们旨在评估无病性突尼斯 DTC 幸存者的 HRQoL，并探讨其决定因素。
我们进行了一项为期三个月的横断面研究，纳入了 266 名诊断为 DTC 的患者。我们使用简短的 36 项健康调查评估了合格参与者的 HRQoL，并与 76 名健康对照进行了比较。
86 名符合条件的 DTC 幸存者主要为女性（89.5%），平均年龄为 44.3 ± 12.5 岁。与参考人群相比，生理功能（PF）、生理角色（RP）和疼痛域显著改变。年龄与 PF、RP、情感角色（RE）和社会功能（SF）呈负相关。肿瘤大小和淋巴结转移分别影响一般健康和 PF。癌症无病生存时间与心理健康（MH）呈正相关。颈部疤痕愈合不良和持续性术后甲状旁腺功能减退显著恶化 MH。疼痛感知与放射性碘累积剂量呈正相关。亚临床甲状腺功能亢进显著降低 PF 和 RP 评分。TSH 抑制与 MH 和 SF 评分呈负相关且强相关。
与突尼斯正常人群相比，DTC 幸存者的 HRQoL 显著降低。这些结果可推广至其他南地中海和非洲国家的类似人群。在该地区制定协调的多学科后续干预措施是必要的，以维持 DTC 幸存者的 HRQoL。
