Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation

Seon Hee Yoo; Smi Choi-Kwon

doi:10.4040/jkan.2013.43.6.801

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Yoo and Choi-Kwon: Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation

Original Article

J Korean Acad Nurs 2013;43(6):801-811.

Published online: 15 December 2013

DOI: https://doi.org/10.4040/jkan.2013.43.6.801

Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation

Seon Hee Yoo¹, Smi Choi-Kwon^2,

¹Nuclear Medicine Department, Asan Medical Center, Seoul

²College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Address reprint requests to : Choi-Kwon, Smi College of Nursing, Research Institute of Nursing Science, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-460,Korea Tel: +82-2-740-8830 Fax: +82-2-766-1852 E-mail: smi@snu.ak.kr

Received 11 May 2013 Revised 26 May 2013 Accepted 22 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

To investigate changes in Quality of life (QOL) and related factors in patients with thyroid cancer undergoing Radioactive Iodine remnant ablation (RAI).

Methods

Data were collected longitudinally 3 times for 6 months (2 weeks post-surgery, post RAI, 3 months post RAI) in a hospital located in Seoul. Questionnaires were used to measure levels of physical symptoms, anxiety, depression, and QOL. Ninety-eight patients with thyroid cancer who had RAI were included in the analysis. Data were analyzed using SPSS (18.0).

Results

Findings for the three data collection times respectfully were: mean scores for physical symptoms, 0.53, 1.21 and 0.62, patients with depression, 47%, 36.7% and 37.7%, patients with anxiety, 18.4 %, 19.4% and 20.4%, mean scores for QOL, 7.06, 7.01 and 7.28. QOL score was highest 3 months post RAI (p=.031). In the stepwise multiple regression analysis, depression and fatigue were predicting factors for low QOL at all data collection times. Dysponia was a predicting factor for low QOL post RAI and 3 months post RAI.

Conclusion

To increase QOL, it is necessary to provide information in advance regarding physical & psychological symptoms and to develop nursing intervention programs to decrease depression and fatigue.

Keywords: Thyroid cancer, Radioactive iodine remnant ablation, Quality of life

References

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Table 1.

Quality of Life according to General Characteristics, Medical Characteristics, Anxiety and Depression at the 3 Different Measurement Times (N=98)

Variables	Categories	n (%)	2 weeks post surgery		Post RAI		3 months post RAI
Variables	Categories	n (%)	Mean or n (%)	t or F (p)	Mean or n (%)	t or F (p)	Mean or n (%)	t or F (p)
Gender	Male	24 (24.5)	7.06	0.01	7.07	0.22	7.23	0.21
	Female	74 (75.5)	7.06	(.999)	6.99	(.825)	7.30	(.838)
Age (year)	<30^a	11 (11.2)	7.40	0.99	7.51	1.13	7.82	2.57
	30-39^b	28 (28.6)	6.78	(.418)	6.72	(.345)	7.02	(.043)
	40-49^c	38 (38.8)	7.17		7.19		7.33	(e<a, b, c, d)
	50-59^d	19 (19.4)	7.17		6.93		7.50
	≥60^e	2 (2.0)	7.06		7.00		4.85
Educational level	≤Middle school	5 (5.1)	7.54	0.56	7.13	0.89	7.91	1.07
	≤High school	44 (44.9)	6.96	(.576)	6.77	(.415)	7.09	(.347)
	≥College	49 (50.0)	7.10		7.10		7.38
Marital status	Married	81 (82.7)	7.04	0.40	6.95	0.82	7.28	0.05
	Single	17 (17.4)	7.17	(.673)	7.30	(.417)	7.29	(.960)
Employment status	Employed	61 (62.2)	7.02	0.39	6.90	0.81	7.12	1.50
	Unemployed	37 (37.8)	7.12	(.699)	7.17	(.419)	7.54	(.136)
Monthly income (10,000 won)	<100	16 (16.3)	6.71	0.86	6.68	0.59	7.14	0.45
	100-200	22 (22.4)	6.93	(.463)	6.96	(.621)	7.14	(.716)
	201-300	19 (19.4)	7.31		7.39		7.59
	>300	41 (41.8)	7.06		6.98		7.26
Stage (AJCC)	I	59 (60.2)	7.10	0.21	7.00	0.33	7.24	0.38
	III	30 (30.6)	7.05	(.781)	6.89	(.643)	7.25	(.644)
	IVA	9 (9.2)	6.82		7.38		7.28
Dose of RAI	80 mCi	50 (51)	7.21	1.24	6.99	0.91	7.27	0.96
	150 mCi	48 (49)	6.90	(.383)	7.02	(.246)	7.28	(.398)
Lymph node	CND, none	74 (74.5)	6.94	1.86	6.85	1.77	7.05	2.98
dissection	MRND	24 (24.5)	7.46	(.066)	7.50	(.080)	7.97	(.004)
Anxiety			7.27	3.70	7.45	6.75	7.71	7.85
	No		80 (81.6)	(<.001)	79 (80.6)	(<.001)	78 (79.6)	(<.001)
			6.19		5.18		5.60
	Yes		18 (18.4)		19 (19.4)		20 (20.4)
Depression			7.75	7.16	7.77	8.05	7.94	7.85
	No		52 (53.0)	(<.001)	62 (63.3)	(<.001)	61 (62.3)	(<.001)
			6.29		5.69		6.19
	Yes		46 (47.0)		36 (36.7)		37 (37.7)

AJCC=American Joint Committee on Cancer; RAI=Radioactive iodine remnant ablation; CND=Central neck dissection; MRND=Modified radical neck dissection.

Table 2.

Changes in Physical Symptoms, Anxiety, Depression & Quality of Life at the 3 Different Measurement Times (N=98)

Variables	2 weeks post surgery	Post RAI	3 months post RAI	F (p)
Variables	M±SD	M±SD	M±SD	F (p)
Total thyroidectomy related physical symptoms (0-10)
Operation site pain	1.74±1.48	1.44±1.51	1.60±1.91	1.94 (.150)
Dysphonia	2.79±2.49	2.08±2.48	2.19±2.69	3.90 (.022)
Hypocalcemia symptom	1.36±1.94	2.15±2.28	1.81±2.31	6.10 (.003)
Radioactive iodine remnant ablation related physical symptoms (0-3)
Edema	0.40±0.73	1.96±0.86	0.79±0.83	138.85 (<.001)
Weight gain	0.37±0.69	1.51±0.99	0.86±0.96	60.80 (<.001)
Nausea	0.32±0.62	1.49±1.06	0.31±0.58	57.20 (<.001)
Dyspepsia	0.39±0.76	1.40±0.95	0.60±0.77	38.22 (<.001)
Loss of appetite	0.71±0.85	1.48±1.04	0.54±0.79	35.87 (<.001)
Taste change	0.42±0.69	1.08±1.08	0.48±0.74	19.50 (<.001)
Vomiting	0.06±0.28	0.64±0.95	0.07±0.27	17.30 (<.001)
Brash	0.31±0.62	0.95±1.02	0.38±0.70	16.90 (<.001)
Constipation	0.32±0.68	0.92±0.98	0.47±0.76	15.66 (<.001)
Cold sensitivity	0.55±0.80	1.13±1.02	0.93±0.89	14.57 (<.001)
Headache	0.72±0.81	1.08±0.90	0.54±0.74	12.60 (<.001)
Dry mouth	0.62±0.79	0.93±0.84	0.67±0.74	6.72 (.002)
Sialoadenitis	0.86±0.91	0.81±0.80	0.56±0.78	5.25 (.007)
Fatigue	1.32±0.89	1.56±0.95	1.50±0.84	2.67 (.072)
Total	0.53±0.40	1.21±0.59	0.62±0.40	75.68 (<.001)
Anxiety	4.59±3.36	4.24±4.00	4.53±3.80	0.66 (.521)
Depression	6.58±4.08	5.76±4.32	6.05±4.30	2.72 (.069)
QOL	7.06±1.22	7.01±1.59	7.28±1.36	3.54 (.031)

RAI=Radioactive iodine remnant ablation QOL=Quality of life.

Table 3.

Test of within Subject Contrast Physical Symptoms & Quality of Life (N=98)

Variables	2 weeks postsurgery vs Post RAI	Post RAI vs 3 months post RAI	2 weeks post surgery vs 3 months post RAI
Variables	F (p)	F (p)	F (p)
Total thyroidectomy related physical symptoms
Operation site pain	0.57 (.452)	1.21 (.274)	3.52 (.064)
Dysphonia	6.95 (.010)	0.19 (.661)	4.11 (.045)
Hypocalcemia symptom	14.07 (＜.001)	2.51 (.117)	3.20 (.077)
Radioactive iodine remnant ablation related physical symptoms
Edema	226.86 (<.001)	142.20 (<.001)	18.50 (<.001)
Weight gain	119.39 (<.001)	30.67 (<.001)	26.37 (<.001)
Nausea	100.65 (<.001)	108.55 (<.001)	0.02 (.885)
Dyspepsia	72.95 (<.001)	51.95 (<.001)	5.17 (.025)
Loss of appetite	51.74 (<.001)	66.68 (<.001)	3.57 (.062)
Taste change	35.47 (<.001)	30.36 (<.001)	0.48 (.488)
Vomiting	32.87 (<.001)	34.49 (<.001)	0.08 (.783)
Brash	33.72 (<.001)	24.64 (<.001)	0.89 (.348)
Constipation	35.52 (<.001)	19.51 (<.001)	4.07 (.046)
Cold sensitivity	25.97 (<.001)	3.25 (.075)	14.26 (＜.001)
Headache	9.02 (.003)	25.20 (<.001)	3.88 (.052)
Dry mouth	10.76 (<.001)	8.29 (.005)	0.35 (.556)
Sialoadenitis	0.21 (.643)	7.91 (.006)	7.03 (.009)
Fatigue	4.75 (.032)	0.31 (.577)	2.85 (.095)
Total	142.37 (<.001)	125.23 (<.001)	6.27 (.014)
Anxiety	1.04 (.309)	0.93 (.338)	0.18 (.674)
Depression	2.82 (.101)	0.70 (.405)	0.16 (.692)
QOL	0.20 (.652)	7.47 (.008)	4.40 (.039)

RAI=Radioactive iodine remnant ablation; QOL=Quality of life.

Table 4.

Correlations between Physical Symptoms and Quality of Life

Variables	2 weeks post surgery	Post RAI	3months post RAI
Variables	r (p)	r (p)	r (p)
Total thyroidectomy related physical symptoms
Operation site pain	−.26 (.010)	−.40 (<.001)	−.35 (<.001)
Dysphonia	−.17 (.257)	−.36 (<.001)	−.51 (<.001)
Hypocalcaemia symptom	−.28 (.006)	−.34 (.001)	−.39 (<.001)
Radioactive iodine remnant ablation related physical symptoms
Edema	−.30 (.002)	−.36 (<.001)	−.46 (<.001)
Weight gain	−.24 (.018)	−.26 (.009)	−.32 (.001)
Nausea	−.19 (.058)	−.21 (.038)	−.39 (<.001)
Dyspepsia	−.41 (<.001)	−.43 (<.001)	−.41 (<.001)
Loss of appetite	−.35 (.001)	−.35 (<.001)	−.33 (.001)
Taste change	−.33 (.001)	−.30 (.003)	−.34 (.001)
Vomiting	−.11 (.277)	−.26 (.010)	−.18 (.085)
Brash	−.35 (<.001)	−.38 (<.001)	−.29 (.004)
Constipation	−.23 (.026)	−.49 (<.001)	−.31 (.002)
Cold sensitivity	−.38 (<.001)	−.26 (.010)	−.26 (.009)
Headache	−.21 (.037)	−.30 (.003)	−.32 (.001)
Dry mouth	−.33 (.001)	−.50 (<.001)	−.47 (<.001)
Sialoadenitis	−.13 (.191)	−.33 (.001)	−.39 (<.001)
Fatigue	−.53 (<.001)	−.55 (<.001)	−.62 (<.001)

RAI=Radioactive iodine remnant ablation.

Table 5.

Stepwise Multiple Regression Model Explaining Quality of Life at the 3 Different Measurement Times

Variables	Categories	B	ß	t	p	R²	Change of R²
2 weeks post surgery	Depression	−1.16	−0.56	−8.19	<.001	.46
	Fatigue	−0.38	−0.28	−3.92	<.001	.57	.11
	Dyspepsia	−0.35	−0.22	−3.17	.002	.61	.04
Post RAI	Depression	−1.12	−0.43	−4.79	<.001	.57
	Constipation	−0.35	−0.22	−3.58	.001	.64	.07
	Dysphonia	−0.09	−0.14	−2.38	.019	.68	.04
	Fatigue	−0.27	−0.16	−2.49	.015	.70	.02
	Anxiety	−0.56	−0.20	−2.25	.027	.71	.01
3 months post RAI	Depression	−0.66	−0.30	−3.33	.001	.55
	Fatigue	−0.46	−0.28	−4.38	<.001	.64	.09
	Anxiety	−0.75	−0.30	−3.32	.001	.64	.00
	Dysphonia	−0.10	−0.20	−3.22	.002	.72	.08

RAI=Radioactive iodine remnant ablation.

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