Radioactive Iodine Symptom Burden, Psychosocial Factors, and Health-related Quality of Life among Differentiated Thyroid Cancer Survivors: A Cross-Sectional Analysis.

Abstract

Background: Few studies have examined whether specific symptoms following radioactive iodine (RAI) treatment are associated with worse health-related quality of life (HRQOL) among patients with differentiated thyroid cancer (DTC), a population that is understudied in cancer survivorship research. More specifically, the relationship between RAI symptom burden and holistic HRQOL measures has not yet been evaluated in this population. This study aimed to 1) evaluate the correlation between a comprehensive patient-reported RAI symptom measure, the SAlivary, LAcrimal, and NaSal measure (SALANS), and HRQOL (FACT-G7) in patients with DTC post-RAI and 2) evaluate the relationships between HRQOL, RAI symptom burden, and psychosocial factors among patients treated with RAI for DTC.

Methods: We recruited participants through a national thyroid cancer patient organization to complete an exploratory cross-sectional online survey. Pearson's correlation coefficients were used to evaluate the associations between the FACT-G7 and SALANS. Hierarchical linear regression models were used to assess the associations between HRQOL, patient-reported RAI symptom burden, and psychosocial factors, controlling for demographic and clinical factors. We used t-tests to identify variables related to clinically meaningful decreases in HRQOL.

Results: Sixty-nine patients (mean age = 40.4 years, SD=14.48) who received RAI treatment (M=1.0, SD= .78) within three years of diagnosis (M=1.4, SD=.77) completed an online survey. Statistically significant moderate negative correlations were found between the RAI symptom burden scales and HRQOL (r= -.39 to -.60, p<.001). Worse HRQOL was significantly associated with greater RAI symptom burden ( $\beta =-.46$ , p =.003), greater distress ( $\beta =-.38$ , p = .003), and lower self-efficacy ( $\beta =.47$ , p = .002), controlling for demographics and clinical factors. Compared with those with high HRQOL, those with low HRQOL reported significantly (p<.05) greater symptom burden related to RAI treatment, particularly xerostomia, sialadenitis, taste changes, dry eyes, epiphora, and nasal symptoms.

Conclusions: Greater RAI symptom burden, distress, and lower self-efficacy were associated with worse HRQOL among patients with DTC after RAI treatment. Identifying treatment- and psychosocial-related risk factors for worse HRQOL could help identify future targets for thyroid cancer survivorship care and patients who may benefit from supportive interventions.