Quality of Life in Patients With Low and Very Low Risk Differentiated Thyroid Cancer Who Underwent Thyroidectomy in Quito-Ecuador 2020

Abstract

\n Low-risk papillary thyroid cancer (less than one centimeter and entrusting the thyroid) is a common pathology, over-diagnosed and therefore mainly over-treated in young women. Considered a public health problem mainly by two premises: 1) psycho-emotional involvement in people who suffer from it and undergo treatments; 2) and because unnecessary interventions are sometimes carried out that represent a futile cost to the health budget, especially for emerging economies such as the Ecuadorian. Objective: Demonstrate the affectation of the quality of life (QoL) after total thyroidectomy in patients with differentiated thyroid cancer of low and very low risk, who underwent surgery with or without adjuvant radioactive iodine treatment. In addition, to identify if variables such as gender, age, and sequelae of surgery such as hypoparathyroidism and scar influence QoL. M&M: A mixed study (qualitative-quantitative) was carried out, where information was collected electronically (via the whats app) and video call from 25 patients who have been affected by low and very low-risk thyroid cancer, in follow-up in the General Hospital San Francisco de Quito. After approval of the study by the teaching department and the ethics committee, we contacted the patients and asked for demographic data (age, gender); clinical data (use of levothyroxine, calcium); and they were also asked to fill out a self-applicable survey of the quality of life of the University of Washington (UW-Qol v.4). Subsequently, an interview with semi-structured questions was carried out and the participants were asked to make a graph of their neck. Results: In the UW-QoL v.4, it was shown that the physical aspects of quality of life, (chewing, swallowing, shoulder, speech, taste, and saliva) scored 90 points on average, did not present as much impact as the emotional aspects (pain, mood, activity, appearance, recreation, and anxiety) with an average of 83 points. In the interview and in the drawing it is corroborated that the emotional aspect where the appearance with the scar and the decrease in activity is included determine a worse quality of life. Neither gender nor age, nor the appearance of hypoparathyroidism determines a worse QoL. Discussion: The QoL for the WHO has elements that influence the physical and emotional health of a subject, their state of independence, and their social and environmental relationship. The study showed that QoL is affected with low and very low risk thyroid cancer on an emotional level, but not physically. This leads us to raise the possibility that differentiated thyroid cancer due to its low risk of mortality and recurrence in patients could be kept on follow-up and benefit from surgery only in the case that in active follow-up, it increased and became intermediate risk (ATA). Studies with a larger patient population are required to determine if support networks are an important parameter that affects QoL.