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THYROID CANCER
Quality of life in patients with low-risk thyroid cancer undergoing active surveillance
BACKGROUND
Thyroid cancer is common and papillary thyroid cancer is the most common type of thyroid cancer. Fortunately, the prognosis of thyroid cancer is excellent due to effective treatments, usually beginning with surgery to remove part or all of the thyroid containing the cancer. Recent data has shown that small thyroid cancers, known as papillary thyroid microcarcinoma, are at a very low risk for growing and spreading outside of the thyroid. Because of this, the option of active surveillance, meaning the cancer is followed by regular ultrasound imaging as opposed to immediate thyroid surgery, is becoming a more common option for thyroid cancer patients.
One concern about active surveillance is whether living with a small, low risk thyroid cancer affects patient’s quality of life as compared to removing the cancer by surgery. This study, part of the Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS), examined the factors driving treatment decisions and compares quality-of-life outcomes over time.
THE FULL ARTICLE TITLE
Kim MJ, et al. Comparison of patient-reported outcomes between active surveillance and immediate lobectomy in patients with low-risk papillary thyroid microcarcinoma: initial findings from the KoMPASS cohort. Thyroid 2024;34(11):1371-1378; doi: 10.1089/thy.2024.0264. PMID: 39287055.
SUMMARY OF THE STUDY
This study was done in Korea. The patients with a diagnosis of low-risk thyroid cancer were divided into 2 groups: active surveillance or surgery (lobectomy). The study included approximately 1000 patients at multiple centers in Korea. More than 70% of the patients were women. Patients electing active surveillance reported higher incomes, smaller cancers and greater awareness of active surveillance. At the baseline the patients who have underwent active surveillance showed a better quality of life as compared to those undergoing surgery. However, at 12 months both groups reported similar quality of life. By 2 years there was no difference in the 2 groups in terms of quality of life.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that patient’s age, size of the cancer and income levels influenced the patient’s decision to choose active surveillance. However, the study demonstrated that despite an early advantage and quality of life for patients undergoing active surveillance, the long-term quality of life was similar in both groups.
— Vibhavasu Sharma, MD, FACE
ATA RESOURCES
Thyroid Cancer (Papillary and Follicular): https://www.thyroid.org/thyroid-cancer/
Thyroid Surgery: https://www.thyroid.org/thyroid-surgery/
ABBREVIATIONS & DEFINITIONS
Papillary thyroid cancer: the most common type of thyroid cancer. There are 4 variants of papillary thyroid cancer: classic, follicular, tall-cell and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).
Papillary microcarcinoma: a papillary thyroid cancer smaller than 1 cm in diameter.
Thyroidectomy: surgery to remove the entire thyroid gland. When the entire thyroid is removed it is termed a total thyroidectomy. When less is removed, such as in removal of a lobe, it is termed a partial thyroidectomy.
Lobectomy: surgery to remove one lobe of the thyroid.
Active surveillance: The practice of following a small, low-risk cancer with regular imaging studies and deferring surgery until the cancer grows or changes. This is compared to immediate surgery to remove the cancer.
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