Survivorship and Quality-of-Life Play Important Roles for Patients With Thyroid Cancer

Melanie Goldfarb, MD, MSc, FACS, FACE

Survivorship does not just mean surviving cancer. According to Melanie Goldfarb, MD, MSc, FACS, FACE, it also means dealing with the physical, emotional, psychological aspects of one's diagnosis.

“Anybody that gets thyroid cancer is a thyroid cancer survivor, so survivorship is from the time of diagnosis. Even more so for thyroid cancer patients as they live a lifetime for the most part, so every year there's more thyroid cancer survivors,” stated Goldfarb, Center for Endocrine Tumors, Providence Saint John's Cancer Institute, in an interview with Targeted Oncology^TM. “But even if [a patient is] surviving, that doesn't mean that they don't have physical, emotional, psychosocial, and things going on that are important to be acknowledged, addressed, and dealt with. In the cancer community until 10-15 years ago on all cancers, it was like, great, let's keep them alive. But now as more people are survivors and living longer, what survivorship means, and all the other things are coming to the forefront.”

Overall, long-term survivorship care is a growing topic of importance when managing patients with cancer, including those with thyroid cancer.

It is important to provide survivorship, care, and assess the needs and quality-of-life for patients with thyroid cancer, as well as their families. To Goldfarb, this should be implemented even for pediatric patients with thyroid cancer and survivors.

In the interview, Goldfarb highlighted the importance of long-term survivorship care and the quality-of-life aspects of patients with thyroid cancer.

Targeted Oncology: Can you define survivorship for patients with thyroid cancer? What research has been done on this topic?

Goldfarb: There's been a couple different articles and symposiums proposed and finally [last] year, we [had] a full survivorship symposium, which is exciting. It’s important because anybody that gets thyroid cancer is a thyroid cancer survivor, so survivorship is from the time of diagnosis. Even more so for thyroid cancer patients as they live a lifetime for the most part, so every year there's more thyroid cancer survivors. But even if [a patient is] surviving, that doesn't mean that they don't have physical, emotional, psychosocial, and things going on that are important to be acknowledged, addressed, and dealt with. In the cancer community until 10-15 years ago on all cancers, it was like, great, let's keep them alive. But now as more and more people are survivors and living longer, what survivorship means, and all the other things are coming to the forefront.

Same thing especially in the thyroid world because they're not usually taken care of in the oncology space. All these survivorship things are not always available or not always brought up. [Experts say, a patient] has thyroid cancer, great, they are done, and they don't acknowledge that a lot of the patients have a lot of other things going on.

What can you discuss about the quality-of-life aspect for patients with thyroid cancer?

From my own research, and what I do, quality-of-life is a big, all-encompassing word. There are emotional, psychosocial, and physical things that have to do with it. There are general measures of quality-of-life that one fills out with some questions, and then there's also some thyroid-specific quality-of-life measurement tools which can be used. There are some differences based on age of patients, based on extensive surgery, based on if they get radioactive iodine, and so on and so forth, but across the board, at least in the direct aftermath of getting care, there usually is a dip in quality-of-life. For many people, that bounces back up to normal after a period of time or about a year, but some of that has to do with, did they have any complications from surgery or are they worrying about other things. Quality-of-life is a big word. In general, it's more appropriate to talk about the specifics of it, but we use it as an all-encompassing word.

In the thyroid cancer space, what does the current treatment landscape look like for patients? What options are available?

In the thyroid cancer world, we are moving towards less is more. We want to do this because we now know that people can do well, are going to live a long time, not have many issues, so now, we want to maximize the quality-of-life and decrease complications. Instead of everybody getting up their whole thyroid out and getting radioactive iodine, we are going towards trying to take out half the thyroid or not getting radioactive iodine. Now for some patients, [we] have to do everything, but for patients that have a smaller, well confined cancer, we're trying to minimize treatment. There have been a couple of studies coming out showing that overall quality-of-life is a bit better for people where we only take out half of their thyroid vs their whole thyroid. Many of us are moving towards doing less. I think that that's a great thing.

Something else, we're not quite doing what we call RFA or laser, non-invasive cancer treatment. We are mostly using it for benign tumors or recurrent cancers, but I think that the jury is out on where that will be a part of the treatment in 5-10 years down the road.

What research is ongoing in this space that you are looking forward to learning about?

The thyroid cancer space never has a ton of clinical trials. The ones that are there focus on medullary thyroid cancers, the anaplastic thyroid cancers, the recurrent iodine refractory tumor. Most of the clinical trials in the drug space are on those bad ones. It's difficult to do a clinical trial with the other low-grade ones. There probably will be a trial starting at some point for doing the RFA or the laser with the small cancers. Some people are doing it off-label, but my guess is that around the corner, we'll do some of those.

What unmet needs still exist in the space?

I do a lot in this space with adolescent, young adult, and pediatric patients. I think that there's tons more to be done in the pediatric arena because it's a rare cancer and we don't see it as much. In the young adult space, it's the number 1 cancer for women aged 15-39 and has overtaken breast cancer. But for children, there's a lot of research to be done. [We must do more looking at if] we cut back like we're doing for the adults on the amount of treatment that we're doing. I think that there's little quality-of-life and survivorship research that has been done in the pediatric space for thyroid cancer, and there's been a ton for pediatric other cancers. So, I think there's a lot of catching up to do.

I definitely think more work in quality-of-life in general and getting patients with thyroid cancer into the survivorship model [is needed] as the rest of the oncology patients have access to. I think it is a huge area and in the thyroid space, a lot of what still needs to be done is, can we do even better at not only diagnosing a lot of these cancers before surgery, but also, which are going to do something bad. Because if we diagnose a cancer and we can figure out that it's never going to do anything, maybe it can be left in. I think that the wave of the future is continuing to perfect our preop diagnosis. Then, can we even further risk stratify based on preoperative markers and which ones are going to do bad things?