Balancing demands of cancer surveillance among survivors of thyroid cancer.

PURPOSE: The purpose of this qualitative study was to explore and describe the demands of long-term cancer surveillance among survivors of thyroid cancer and how these perceived demands influence their quality of life. DESCRIPTION OF STUDY: The sample consisted of 34 participants who had undergone thyroid hormone withdrawal before body scanning for evaluation of cancer recurrence and/or metastatic disease. Participants completed two self-report instruments: 1) a Demographic Data Tool, and 2) three open-ended questions about quality of life during thyroid hormone withdrawal. The participants wrote down their answers to the demographics and open-ended questions.
RESULTS: The 34 participants had a mean age of 40 years (range, 22-73 years); 85% were women and 74% were white. All were high school educated, and 32% were college graduates. Sixty-eight percent were married, and 75% were employed either full- or part-time. Participants experienced profound changes in relationship to withdrawal from thyroid hormone medication. These changes in physical well-being coupled with the potential for disease recurrence influenced their psychological and social well-being. Balancing the demands of cancer surveillance (through body scanning and thyroid hormone withdrawal) against day-to-day living had a major influence on perceptions of quality of life. CLINICAL IMPLICATIONS: Study results support other studies and clinical reports that physical symptoms related to thyroid hormone withdrawal were profound, severe, and debilitating. First, participants with thyroid cancer had to learn through their own personal experiences what physical limitations were imposed during the period of surveillance testing. Second, the physical changes and anticipation of body scanning exerted a profound effect on psychological and social well-being. Feelings of loss, anxiety, depression, and loss of concentration were very difficult to endure. Third, given the general characteristics of this population of thyroid cancer survivors who generally are younger and working, the experience of hypothyroidism can have a major impact on work schedules. Individuals who require a large amount of concentrated attention to work tasks may need to modify their work schedules during hypothyroid states. Findings suggest that individuals who are considered "cured" of their disease are a largely forgotten segment of cancer survivors. However, participants in this study continued to inform us of the process of cancer survivorship and the need for exploring quality-of-life concerns, regardless of prognosis.