Attention to Quality of Life

The physician in charge of the continuity in care of the thyroid cancer patient (likely the endocri-nologist) is instrumental in promoting compliance with the long-term follow-up and the required repeat investigations. Compliance can be enhanced by giving attention to many details which - although not determining the main outcome of the disease - may severely affect the patient's life. The cost of care should not be forgotten, as patients may have no or insufficient insurance [44]. The incidence of chronic xerostomia as a result of 131I-induced sialadenitis may decrease considerably with amifostine pretreat-ment [45]. During thyroid hormone withdrawal, hypothyroid symptoms are common such as fatigue, weight gain, peripheral edema, muscle cramps, skin dryness, anxiety, constipation, cold, depression, and impairment of memory and concentration; these complaints are more pronounced in the elderly than in younger patients [45]. It is thus not surprising that quality-of-life questionnaires indicate significant reduction in physical, psychosocial, and social wellbeing in this period. Whereas troublesome physical symptoms relating to thyroid hormone withdrawal are readily appreciated, the negative psychological, family, and work sequelae are less apparent [46]. The professional consequences of the hypothyroid period should not easily be dismissed: 11 to 14 days of missed work are on average associated with T4 withdrawal [42]. Adequate information to the patient and reassurance of the relatively good prognosis may greatly enhance compliance. It is often helpful to give addresses of patient support groups and of websites with useful information. Nevertheless, it is not unusual that patients refuse to undergo another period of T4 withdrawal in view of their past experience with this procedure; the fear of another depressive episode can be quite realistic. In such cases the use of rhTSH greatly promotes compliance [47]. A much wider use of rhTSH replacing T4 withdrawal is foreseen in the near future, and this will certainly increase the quality of life of thyroid cancer patients and decrease the number of days of missed work [42].

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