Quality of life with well-differentiated thyroid cancer: Treatment toxicities and their reduction

Introduction: Patients with well-differentiated thyroid cancer have a good prognosis but a significant chance for local recurrence. In the past, limited surgery with postoperative I-131 only for extremely high-risk cases or recurrence was not uncommon. As more aggressive surgical and postoperative treatments appear to gain wider acceptance, toxicity and long-term morbidity become more important issues. Our goal is to present the experience of a single institution with emphasis on oral side effects related to I-131 as well as acute and chronic symptoms related to this diagnosis and their impact on quality of life. Methods: Fifty-seven patients were followed for a median time of 19.3 months. All patients received therapeutic I-131 (mean dose, 154.7 mCi) between January 1, 1996 and August 30, 2002. Results: Fifty-four patients (94.7%) were alive at the time of analysis. Sixteen (28.1%) required a second treatment: any sign of persistence resulted in retreatment. Complaints with I-131 treatment included altered taste, 26.3%; acute xerostomia, 21.1%; and acute sialoadenitis, 15.8%. Chronic xerostomia occurred in 6 (35.3%) of all patients who received multiple treatments. The incidence of chronic xerostomia was reduced to 1 of 11 (9.1%) with amifostine pretreatment. Other chronic side effects associated with this disease included fatigue 54.4%, weight gain of more than 6 months duration 24.6%, with 12 (27.9%) of those under 60 experiencing an average gain of 2.3 kg from initial diagnosis. Conclusion: Review of treatment-related symptoms prompted policies to reduce toxicity including arnifostine pretreatment for I-131 therapy and thyrotropin (synthetic TSH) use in place of iatrogenic hypothyroidism for thyroglobulin testing and scanning.