Longitudinal Assessment of Quality of Life Following Molecular Testing for Indeterminate Thyroid Nodules - PubMed (original) (raw)
Randomized Controlled Trial
. 2021 Dec;28(13):8872-8881.
doi: 10.1245/s10434-021-10375-6. Epub 2021 Jul 22.
Affiliations
- PMID: 34292427
- PMCID: PMC8591007
- DOI: 10.1245/s10434-021-10375-6
Randomized Controlled Trial
Longitudinal Assessment of Quality of Life Following Molecular Testing for Indeterminate Thyroid Nodules
Max A Schumm et al. Ann Surg Oncol. 2021 Dec.
Abstract
Background: Molecular testing can refine the risk of malignancy in cytologically indeterminate thyroid nodules and can reduce the need for diagnostic thyroidectomy. However, quality of life (QOL) in patients mananged with molecular testing is not well studied.
Objective: We aimed to assess the QOL of patients undergoing surveillance after a benign molecular test result, or thyroidectomy after a suspicious molecular test result.
Methods: This prospective longitudinal follow-up of the Effectiveness of Molecular Testing Techniques for Diagnosis of Indeterminate Thyroid Nodules randomized trial utilized the Thyroid-Related Patient-Reported Outcome, 39-item version (ThyPro-39) to assess the QOL of patients with indeterminate cytology on thyroid fine needle aspiration (FNA) biopsy. All patients underwent molecular testing at the time of initial FNA. A mixed-effect model was used to determine changes in QOL over time.
Results: Of 252 eligible patients, 174 completed the assessment (69% response rate). Molecular test results included 72% (n = 124) benign and 28% (n = 50) suspicious. ThyPro-39 scores of benign molecular test patients were unchanged from baseline (following initial FNA and molecular test results) to 18 months of ultrasound surveillance. Baseline symptoms of goiter, anxiety, and depression were more severe for patients with suspicious compared with benign molecular test results. At a median of 8 months after thyroidectomy, suspicious molecular test patients reported improved symptoms of goiter, anxiety, and depression.
Conclusion: A benign molecular test provides sustained QOL throughout ultrasound surveillance, without worsening anxiety or depression relating to the risk of malignancy. Definitive surgery results in improvement of QOL in patients with suspicious molecular tests.
© 2021. The Author(s).
Conflict of interest statement
Max A. Schumm, Dalena T. Nguyen, Jiyoon Kim, Chi-Hong Tseng, Amy Y. Chow, Na Shen, and Masha J. Livhits have no related conflicts of interest to declare.
Figures
Fig. 1.
Flow diagram for all patients with indeterminate thyroid nodules who consented to complete the ThyPro-39 QOL study throughout UCLA Health (August 2017–January 2020). Baseline survey completed 0–4 months after FNA biopsy; early survey completed 4–12 months after FNA; late survey completed 12–24 months after FNA. QOL quality of life, ThyPro-39 Thyroid-Related Patient-Reported Outcome, 39-item version, UCLA University of California Los Angeles, FNA fine needle aspiration
Fig. 2.
Change in ThyPro-39 QOL scale scores throughout ultrasound surveillance in benign molecular test result patients (n = 124). ThyPro-39 Thyroid-Related Patient-Reported Outcome, 39-item version, QOL quality of life
Fig. 3.
Comparison of baseline and postoperative ThyPro-39 QOL domains in patients with suspicious molecular test results who underwent thyroidectomy. Postoperative QOL assessment included 35 patients comprising 54 observations at a median of 8 months after thyroidectomy. * QOL significantly improved after thyroidectomy for symptoms of goiter, anxiety, depression, impaired social life, and impaired daily life (p < 0.05). ThyPro-39 Thyroid-Related Patient-Reported Outcome, 39-item version, QOL quality of life
Comment in
- ASO Author Reflections:Improving the Quality of Life of Patients with Indeterminate Thyroid Nodules Receiving Molecular Testing.
Schumm MA, Livhits MJ. Schumm MA, et al. Ann Surg Oncol. 2021 Dec;28(13):8882-8883. doi: 10.1245/s10434-021-10398-z. Epub 2021 Jul 2. Ann Surg Oncol. 2021. PMID: 34215954 No abstract available.