The Thyroid Cancer Modified Anxiety Scale (TC-MAX): Development and External Validation of a Thyroid Cancer Distress Instrument.

IF 6.6 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Thyroid Pub Date : 2026-10-01 Epub Date: 2026-08-11 DOI:10.1177/10507256261475819

Amanda J Bastien, Sungjin Kim, Cynthia Zalt, Iris Cong, Jewel Ng, Caroline Marshall, Christopher V Almario, Omer Liran, Brennan M R Spiegel, Jon Mallen-St Clair, Evan S Walgama, Kevin S Scher, Julie K Jang, Yufei Chen, Samuel Zhang, Gary Bloom, Michelle M Chen, K Linnea Peterson, Wendy L Sacks, Zachary S Zumsteg, Allen S Ho

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引用次数: 0

Abstract

Background: Patient distress associated with thyroid cancer greatly influences treatment choice, yet is underestimated by clinicians. We developed and validated the Thyroid Cancer Modified Anxiety Scale (TC-MAX) to measure patient-reported thyroid cancer-related worry.

Methods: Development entailed (1) conceptualization (systematic literature review, expert panel [n = 4], patient focus groups [n = 10]); (2) qualitative revision (pilot testing [n = 59], expert panel [n = 4], patient feedback [n = 4]); (3) internal validation (n = 148); and (4) external validation (n = 1002), with papillary thyroid cancer patients. Internal consistency, test-retest reliability, exploratory/confirmatory factor analysis, and construct validity were evaluated. Severity categories and minimal clinically important differences (MCIDs) were determined.

Results: An 18-question scale was constructed, encompassing three subscales (Collective Anxiety, Ultrasound Anxiety, and Fear of Recurrence/Progression). Internal validation revealed high internal consistency (Cronbach's α = 0.93), excellent test-retest reliability (intraclass correlation coefficient [ICC] 0.86), and significant construct validity (Distress Thermometer [Spearman's $ρ$ = 0.56, p < 0.001], Hospital Anxiety Depression Scale [HADS] [Spearman's ρ = 0.52, p < 0.001], and Functional Assessment of Cancer Therapy-General [FACT-G] [Spearman's $ρ$ = -0.50, p < 0.001]). Exploratory factor analysis showed expected loadings for respective subscales, and confirmatory factor analysis confirmed that the structure was parsimonious. External validation exhibited similar psychometrics, including internal consistency (Cronbach's α = 0.94), test-retest reliability (ICC 0.87), and construct validity (Distress Thermometer [Spearman's $ρ$ = 0.54, p < 0.001], HADS [Spearman's $ρ$ = 0.67, p < 0.001], and FACT-G [Spearman's $ρ$ = -0.62, p < 0.001]). Proposed ranges (low = 0-26, moderate = 26-43, and severe = 43-100) were in excellent agreement between internal and external validation cohorts (weighted κ = 0.84, p < 0.001). Anchor-based MCID was found to be 16.7 (active surveillance vs. surgery) (25.9 [standard deviation (SD) ± 16.4] vs. 42.6 [SD ± 23.3], p < 0.001) or 16.9 (hemithyroidectomy vs. thyroidectomy) (33.6 [SD ± 17.4] vs. 50.5 [SD ± 24.1], p = 0.005).

Conclusions: TC-MAX represents the first dedicated measure of anxiety in thyroid cancer. It exhibits robust psychometric properties in a vulnerable population, accounting for complex viewpoints. The scale effectively assesses preference and informs patients, including determining fit for active surveillance or extent of surgery.

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甲状腺癌改良焦虑量表（TC-MAX）：一种甲状腺癌焦虑量表的开发和外部验证。

背景：与甲状腺癌相关的患者痛苦极大地影响了治疗选择，但被临床医生低估了。我们开发并验证了甲状腺癌修正焦虑量表（TC-MAX）来测量患者报告的甲状腺癌相关担忧。方法：发展包括：(1)概念化（系统文献综述，专家小组[n = 4]，患者焦点小组[n = 10]）；(2)定性修订（中试[n = 59]，专家小组[n = 4]，患者反馈[n = 4]）；(3)内部验证（n = 148）；(4)外部验证（n = 1002），伴有甲状腺乳头状癌的患者。评估内部一致性、重测信度、探索性/验证性因子分析及构念效度。确定严重程度分类和最小临床重要差异（MCIDs）。结果：构建了一个18题的量表，包括三个子量表（集体焦虑、超声焦虑和对复发/进展的恐惧）。内部验证显示高内部一致性（Cronbach's α = 0.93），极好的重测信度（类内相关系数[ICC] 0.86），显著的结构效度（痛苦温度计[Spearman's ρ = 0.56, p < 0.001]，医院焦虑抑郁量表[HADS] [Spearman's ρ = 0.52, p < 0.001]，和癌症治疗功能评估[事实- g] [Spearman's ρ = -0.50, p < 0.001]）。探索性因子分析显示各子量表的预期负荷，验证性因子分析证实结构是简约的。外部验证显示出类似的心理测量指标，包括内部一致性（Cronbach's α = 0.94）、重测信度（ICC 0.87）和结构效度（痛苦温度计[Spearman's ρ = 0.54, p < 0.001]、HADS [Spearman's ρ = 0.67, p < 0.001]和事实- g [Spearman's ρ = -0.62, p < 0.001]）。建议的范围（低= 0-26，中等= 26-43，严重= 43-100）在内部和外部验证队列之间非常一致（加权κ = 0.84, p < 0.001）。基于锚定的MCID为16.7（主动监测vs手术）（25.9[标准差（SD）±16.4]vs. 42.6 [SD±23.3],p < 0.001）或16.9（甲状腺切除术vs.甲状腺切除术）（33.6 [SD±17.4]vs. 50.5 [SD±24.1],p = 0.005）。结论：TC-MAX是首个甲状腺癌患者焦虑的专用测量指标。它在弱势群体中表现出强大的心理测量特性，说明了复杂的观点。量表有效地评估偏好并告知患者，包括确定是否适合主动监测或手术范围。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thyroid 医学-内分泌学与代谢

CiteScore

12.30

自引率

6.10%

发文量

195

审稿时长

6 months

期刊介绍： This authoritative journal program, including the monthly flagship journal Thyroid, Clinical Thyroidology® (monthly), and VideoEndocrinology™ (quarterly), delivers in-depth coverage on topics from clinical application and primary care, to the latest advances in diagnostic imaging and surgical techniques and technologies, designed to optimize patient care and outcomes. Thyroid is the leading, peer-reviewed resource for original articles, patient-focused reports, and translational research on thyroid cancer and all thyroid related diseases. The Journal delivers the latest findings on topics from primary care to clinical application, and is the exclusive source for the authoritative and updated American Thyroid Association (ATA) Guidelines for Managing Thyroid Disease.