Introduction
Methods
Search strategy
Study selection and inclusion criteria
Criteria | Inclusion |
---|---|
Population | Adults with thyroid cancer |
Outcomes | Utility values obtained from EQ-5D-3L questionnaires, HRQoL questionnaires which can be converted to EQ-5D-3L utility estimates (HUI, SF-36, EORTC QLQ-C30), or from TTO and SG studies |
Study design | Studies designed to specifically collect HRQoL data, or as part of an RCT or prospective observational study |
Date | Clinical and economic searches from January 1999 to April 2019 |
Language | English language only |
Data extraction and synthesis
Results
Sample characteristic | Publication | Population/country | Intervention | Study design | Sample size | Type of HRQoL assessment tool | Specific HRQoL assessment tool used | Reported health states | Response rate | Missing data |
---|---|---|---|---|---|---|---|---|---|---|
DTC | ||||||||||
HRQoL assessed in a whole population (no specific intervention) | ||||||||||
UK general population asked to evaluate thyroid cancer health states | Population: RR-DTC Country: UK | None | Vignette health states evaluated through asking a sample of the general public | N = 100 | TTO interviews | Vignette health states evaluated via interview | Observed (unadjusted) utility values: stable/no response, response to therapy, progressive disease, diarrhoea, fatigue, hand and foot syndrome, alopecia | NR | NR | |
Patients with DTC admitted to hospital | Haraj [55] | Population: DTC admitted to hospital Country: Morocco | None | Observational cross-sectional | N = 124 | Patient-reported survey | SF-36 | Average HRQoL across DTC population | NR | NR |
Patients with long-standing DTC | Hedman (abstract) [24] Hedman [25] (Full publication of Hedman abstract) Hedman [17] | Population: DTC (14–17 years post-diagnosis) Country: Sweden | None | Prospective | N = 279 | Patient-reported survey | SF-36 | Average HRQoL across DTC population, sub-groups according to number of comorbidities, self-reported recurrence and general attitude to life; major, moderate or no thyroid-related symptoms; patients with and without thyroid symptoms | 79% | SF-36 scoring software used to handle missing values |
Patients with long-standing DTC | Hedman [54] | Population: DTC (diagnosed between 2012–2017) Country: Sweden | None | Prospective | N = 487 | Patient-reported survey | SF-36 | Average across all patients at diagnosis and a year after diagnosis, sub-groups according to TSH suppression, attitude to life and fear of recurrence, presence of recurrence | 72% (67% at one-year follow-up) | SF-36 scoring software used to handle missing values |
Attendees at patient–doctor thyroid cancer forum | McIntyre [51] | Population: DTC with a diagnosis at least 6 months prior to assessment Country: UK | None | Cross-sectional | N = 82 | Generic preference-based | EQ-5D | Population mean | Only completed questionnaires used | NR |
Patients with DTC who had undergone a total or near total thyroidectomy and RAI | Ratki [29] | Population: patients with DTC treated with RAI Country: Iran | None | Cross-sectional | N = 435 | Patient-reported survey | EORTC QLQ-30 | Whole group mean reported | 94.5% | NR |
Patients who were hospitalised for radioiodine administration and were hypothyroid as a result of short-term thyroid hormone withdrawal | Population: Patients with DTC hospitalised for RAI or whole body scanning and outpatients post-RAI Country: Germany | RAI | Cross-sectional | N = 136 (completing) | Patient-reported survey | SF-36 | Whole group mean, summary scores for the two groups studied and the inpatient group split into those receiving RAI and those receiving a diagnostic body scan | 96% | Discarded incomplete responses | |
Patients with DTC; most had undergone surgery and RAI | Tan [33] | Population: Patients with PTC or FTC Country: Singapore | None during study period | Prospective | N = 152 | Patient-reported survey | SF-36 | Whole group mean reported | 52.4% | 8 removed due to incomplete responses |
Thyroid cancer survivors | Wang [52] | Population: majority had DTC Country: China | None | Population-based survey | N = 965 | Patient-reported survey | SF-36 & EORTC QLQ-C30 | SF-36: in 10-year age brackets | 62% | According to SF-36 and EORTC QLQ-C30 developer’s guidelines |
RAI and surgery | ||||||||||
Patients attending follow-up clinic for a whole body scan after initial surgery and RAI Levothyroxine withdrawal is necessary prior to the whole body scan | Botella-Carretero [21] | Population: thyroid cancer post-surgery during levothyroxine withdrawal Country: Spain | Post-thyroidectomy | Prospective | N = 18 | Patient-reported survey | SF-36 | Patient group at baseline and two follow-up points | Only respondents with completed questionnaires were included | NR |
Patients with biopsy positive PTC | Economopoulos (abstract) [35] | Population: patients with PTC Country: US | Surgery for thyroid cancer | Prospective | N = 55 | Generic preference-based | EQ-5D | Change from baseline to post-op and 6 month follow-up | 60% (both pre-op and post-op questionnaires completed) | NR |
HRQoL estimates elicited from physicians and nurses who care for people with thyroid cancer | Esnaola [36] | Populations: patients with PTC Country: USA | Thyroid lobectomy and total thyroidectomy | Decision analysis with TTO to elicit utility values | N = 15 | TTO—interviews | Vignette health states evaluated via interview | Systemic recurrence of thyroid cancer and four disease-free states after surgical procedures | Only respondents with completed questionnaires were included | N/A |
HRQoL data which were routinely collected in a nuclear medicine department of patients with DTC attending for RAI | Gamper [23] | Population: DTC prior to RAI treatment Country: Austria | RAI | Retrospective analysis of data on file | N = 241 (total patients) | Patient-reported survey | EORTC QLQ-30 | Mean across baseline and all follow-up time points | 72% | 92 patients excluded with only one assessment |
Patients undergoing surgery for papillary thyroid cancer | Gou [20] | Population: patients with PTC Country: China | Surgery for thyroid cancer | Prospective observational | N = 186 | Patient-reported survey | SF-36 | Mean across baseline and four points of follow-up | Only respondents with completed questionnaires were included | N/A |
Patients undergoing thyroidectomy of two types | Huang [26] | Population: patients with PTC undergoing thyroidectomy Country: China | Endoscopic thyroidectomy (experimental group) Open thyroidectomy (control group) | Prospective | N = 198 | Patient-reported survey | SF-36 | Experimental and control groups at two time points post-surgery (1 month and 6 months) | Only respondents with completed questionnaires were included | N/A |
Patients undergoing thyroidectomy | Kebebew [37] | Population: patients with low-risk DTC Country: USA | Thyroidectomy | Cross-sectional | N = 42 | Standard gamble | No specific tool used | Thyroidectomy complications, DTC recurrence, and DTC mortality for low-risk patients | Only respondents with completed questionnaires were included | NR |
Patients undergoing thyroidectomy of two types | Lee [27] | Population: patients with PTC undergoing thyroid lobectomy Country: Korea | Endoscopic thyroidectomy (experimental group) Open thyroidectomy (control group) | Prospective | N = 308 | Patient-reported survey | EORTC QLQ-30 | Experimental and control groups at baseline and three time points post-surgery (1 month and 6 months) | 44% | NR |
Patients undergoing surgery for papillary thyroid cancer | Lubitz [38] | Population: patients with PTC Country: US | Thyroidectomy | Prospective | N = 117 | Generic preference-based | EQ-5D | Pre-treatment and then at two different follow-up times | 48% | 22 cases of missing data that were dealt with using a hot deck procedure stratified by sex, age group and survey time point |
Patients with newly diagnosed PTC or FTC who had undergone thyroidectomy surgery in the previous 2 weeks | Pacini [28] | Population: patients treated with ablation for remnant thyroid; two groups one in hypothyroid one in euthyroid states Country: Europe and North America | Thyroid remnant ablation | Prospective | N = 63 | Patient-reported survey | SF-36 | Baseline at 4 week follow-up for both groups | Only respondents with completed questionnaires were included | N/A |
Patients who had been treated for DTC with RAI, with or without surgery between 2009 and 2013 but were free of thyroid cancer at the time of the study | Rogers [19] | Population: patients with DTC who had been treated with RAI but were disease-free at the time of the study Country: UK | None | Prospective | N = 169 | Patient-reported survey | EORTC QLQ-30 | Whole group mean and results in age groups reported | 68% | NR |
Patients scheduled to undergo thyroid surgery | Shah [30] | Population: patients with well-DTC Country: Canada | Thyroid surgery | Prospective | N = 76 | Patient-reported survey | SF-36 | Pre-operatively and at 3 time points post-operatively | 71% at 12 month follow-up | NR |
Patients with DTC requiring radioiodine | SMC [45] Blamey [56] Haugen [57] | SMC (2015)b population: patients medullary with thyroid cancer Haugen et al. (1999) population is patients with DTC Country: USA | Recombinant human TSH | SMC cites Blamey et al. (2005), which is a literature review that references Haugen et al. (1999) as the source of utility data. The values are not found in the Haugen et al. (1999) publication | N = 229 | SF-36 | SF-36 converted to EQ-5D within the study with mapping | Progressed and non-progressed disease | NR | NR |
Drug treatments | ||||||||||
Patients treated with thyroxine but disease-free at the time of analysis | Crevenna [22] | Population: patients with non-metastatic thyroid cancer being treated with thyroxine Country: Germany | Thyroxine | Cross-sectional | N = 150 | Patient-reported survey | SF-36 | Difference from utility values of general population without cancer | 100% | Nurse present when patient filling out questionnaires to avoid missing answers |
Patients with locally advanced or metastatic RR-DTC | Schlumberger (abstract) [48] SMC [50] | Population: RR-DTC Country: Multinational | Sorafenib | Phase III trial | N = 417 (SMC submission reports N = 416) | Generic preference-based | EQ-5D | Treatment effect | 96% | NR |
Patients with locally advanced or metastatic RR-DTC Did not directly collect utility data | Tremblay (abstract) [49] | Population: RR-DTC Country: multinational (details of countries not included in abstract) | Lenvatinib or sorafenib | Combined analysis of vignette utility values (Fordham et al. [46]) and the effectiveness evidence from clinical trials | NR | TTO vignettes | No specific tool used | Disutility from lenvatinib treatment, disutility from sorafenib treatment | NR | NR |
Patients with DTC; cross-sectional element provided baseline HRQoL data for a total DTC group and a euthyroid group as a comparative control Prospective patients were randomised to the exercise training intervention or a control group | Vigario [34] | Population: patients with DTC on levothyroxine (subclinical hyperthyroidism) Country: Brazil | Supervised exercise training programme | Both cross-sectional and prospective elements | Subclinical hyperthyroidism (N = 33) Euthyroid subjects (N = 49) | Patient-reported survey | SF-36 | Baseline HRQoL from the cross-sectional element of the study and 3 month follow-up for the prospective groups | 100% at baseline and 3 month follow-up | NR |
GTC | ||||||||||
Populations not assessed for a specific intervention | ||||||||||
Patients treated for thyroid cancer | Husson [39] Mols [9] | Population: patients with a diagnosis of thyroid cancer on a national registry Country: Holland | None | Cross-sectional | N = 307 (N = 293 in Mols) | Patient-reported survey | EORTC QLQ-30 | HRQoL according to time since diagnosis, sub-groups according to patient age | 86% | NR |
Patients who had filled in a questionnaire measuring optimism and the SF-36 during their time being treated for thyroid cancer | Kung [40] | Population: patients with thyroid cancer. Most (65%) had disease stage 1 Country: USA | None | Retrospective | N = 104 | Patient-reported survey | SF-36 | The population is split into four groups according to their level of optimism | N/A Retrospective identification | NR |
Patients who had been treated at hospital for thyroid cancer | Roberts [41] | Population: patients who had previously been treated for thyroid cancer Country: USA | None | Cross-sectional | N = 62 | Patient-reported survey | EORTC QLQ-30 | Whole group mean reported | 43% | NR |
Patients who answered ‘yes’ to a question about receiving a medical diagnosis of thyroid cancer | Ryu and Hwang [53] | Population: national survey data which included some thyroid cancer survivors Country: South Korea | None | Retrospective analysis of data on file | N = 125 | Generic preference-based | EQ-5D | Whole group mean | Only respondents with completed questionnaires were included | N/A |
Broad population of people with thyroid cancer | Singer [43] | Population: patients with thyroid cancer admitted to a rehabilitation clinic Country: Germany | None | Cross-sectional | N = 121 | Patient-reported survey | EORTC QLQ-30 | HRQoL according to type of thyroid cancer, by sex and according to a range of prognostic indicators | NR N = 121 is responders only | Missing values imputed |
RAI and Surgery | ||||||||||
Patients enrolled on the ESTIMABL trial in two groups according to TSH and RAI method | Borget [44] | Population: patients undergoing TSH stimulating methods and RAI Country: multinational | RAI | Prospective | N = 752 | Generic preference-based | EQ-5D | Mean utility values by method of stimulation and RAI at the time of RAI | 91% | The number missing for each level is reported in a table in the publication |
Drug treatments | ||||||||||
Patients undergoing a whole body scan as part of their thyroid cancer treatment | Schroeder [42] | Population: patients with thyroid cancer Country: USA | Whole body scanning and thyroxine | Prospective | N = 229 | Patient-reported survey | SF-36 | Baseline while on levothyroxine therapy, after recombinant human thyroid stimulant therapy while still on levothyroxine and on the day of the body scan or after thyroid hormone withdrawal but on the day of the body scan | 98% | NR |
Population | Publication | Health states | Utility values (SD) | Source | |
---|---|---|---|---|---|
DTC | |||||
HRQoL assessed in a whole population (no specific intervention) | |||||
RR-DTC | Stable/no response | 0.80 (0.19) | Vignette values | ||
Response to therapy (any form of treatment) | 0.86 (0.15) | ||||
Progressive disease | 0.50 (0.28) | ||||
Diarrhoea | 0.42 (0.29) | ||||
Fatigue | 0.72 (0.24) | ||||
Hand and foot syndrome | 0.52 (0.30) | ||||
Alopecia | 0.75 (0.21) | ||||
DTC patients admitted to hospital | Haraj [55] | Whole group mean | 0.494 | SF-36 mapped to EQ-5D | |
D TC (diagnosis 14–17 years previously) | Hedman [24] | At least one thyroid symptom | 0.820 | SF-36 mapped to EQ-5D | |
No thyroid symptoms | 0.986 | ||||
DTC (diagnosis 14–17 years previously) | Hedman [25] | Total group | 0.846 | SF-36 mapped to EQ-5D | |
0 self-reported comorbidities | 0.915 | ||||
1 self-reported comorbidity | 0.875 | ||||
2 or more self-reported comorbidities | 0.642 | ||||
Self-reported recurrence | 0.795 | ||||
Concern of self-reported recurrence | 0.815 | ||||
No concern of self-reported recurrence | 0.883 | ||||
Negative view of life | 0.658 | ||||
Positive view of life | 0.868 | ||||
DTC (diagnosis 14–17 years previously) | Hedman [18] | Major thyroid-related symptoms | 0.711 | SF-36 mapped to EQ-5D | |
Moderate thyroid-related symptoms | 0.921 | ||||
No thyroid-related symptoms | 0.994 | ||||
DTC | Hedman [54] | At diagnosis | SF-36 mapped to EQ-5D | ||
Negative view of life | 0.710 | ||||
Positive view of life | 0.823 | ||||
No fear of recurrence | 0.857 | ||||
Seldom fear recurrence | 0.803 | ||||
Often fear recurrence | 0.757 | ||||
Total | 0.792 | ||||
At one-year follow-up | |||||
Negative view of life | 0.737 | ||||
Positive view of life | 0.870 | ||||
No fear of recurrence | 0.864 | ||||
Seldom fear recurrence | 0.863 | ||||
Often fear recurrence | 0.760 | ||||
Presence of recurrence | 0.745 | ||||
Total | 0.842 | ||||
Moderate TSH suppression | 0.855 | ||||
Mild TSH suppression | 0.745 | ||||
No TSH suppression | 0.878 | ||||
Recurrence | 0.745 | ||||
No recurrence | 0.853 | ||||
DTC with a diagnosis at least 6 months previously | McIntyre [51] | Whole DTC population | 0.776 (0.26) | EQ-5D | |
DTC patients post-thyroidectomy and RAI | Ratki [29] | Whole group mean | 0.819 | EORTC QLQ-30 mapped to EQ-5D | |
DTC patients who are undergoing thyroid hormone withdrawal awaiting radioiodine treatment | Tagay [31] | Whole group mean | 0.708 | SF-36 mapped to EQ-5D | |
DTC patients post-thyroidectomy and RAI | Tan [33] | Whole group mean | 0.859 | SF-36 mapped to EQ-5D | |
Thyroid cancer survivors | Wang [52] | Whole population mean | 0.927 | EORTC QLQ-30 mapped to EQ-5D | |
Females | SF-36 mapped to EQ-5D | ||||
Aged 14–24 | 0.832 | ||||
Aged 25–34 | 0.919 | ||||
Aged 35–44 | 0.900 | ||||
Aged 45–54 | 0.857 | ||||
Aged 55–64 | 0.856 | ||||
Aged ≥ 65 | 0.787 | ||||
Males | |||||
Aged 25–34 | 0.927 | ||||
Aged 35–44 | 0.921 | ||||
Aged 45–54 | 0.920 | ||||
Aged 55–64 | 0.921 | ||||
Aged ≥ 65 | 0.861 | ||||
RAI and surgery | |||||
DTC | Botella-Carretero [21] | Baseline (last day on current levothyroxine dose) | 0.218 | SF-36 mapped to EQ-5D | |
4–7 days after levothyroxine withdrawal | 0.222 | ||||
The day before administering RAI for whole body scanning | 0.185 | ||||
SMC [45] Blamey [56] Haugen [57] | Progressed disease | 0.624 | SF-36 mapped to EQ-5D values presented within the publications – no further mapping required | ||
Non-progressed disease | 0.796 | ||||
Gamper [23] | Mean across pre-treatment with RAI and post-treatment | 0.910 | EORTC QLQ-30 mapped to EQ-5D-3L | ||
Patients with previous DTC | Rogers [19] | Whole group mean | 0.916 | EORTC QLQ-30 mapped to EQ-5D | |
Aged under 40 | 0.914 | ||||
Aged between 40 and 49 | 0.911 | ||||
Aged between 50 and 64 | 0.922 | ||||
Aged over 65 | 0.900 | ||||
Patients with DTC undergoing thyroid surgery | Shah [30] | Baseline | 0.856 | SF-36 mapped to EQ-5D | |
3 months follow-up | 0.824 | ||||
6 months follow-up | 0.899 | ||||
12 months follow-up | 0.947 | ||||
Patients with PTC | Economopoulos [35] | Change from pre-op to post-op | 0.020 (0.15) | EQ-5D-3L | |
Change from pre-op to 6 month follow-up | − 0.016 (0.09) | ||||
Change from post-op to 6 month follow-up | − 0.023 (0.1) | ||||
Esnaola [36] | Disease-free after thyroid lobectomy | 0.99 | TTO | ||
Disease-free after total thyroidectomy/radioiodine therapy | 0.95 | ||||
Disease-free after thyroid surgery/permanent complication | 0.88 | ||||
Disease-free after surgery for cervical recurrence | 0.95 | ||||
Systemic recurrence | 0.60 | ||||
Lubitz [38] | Pre-treatment | 0.895 (0.103) | EQ-5D-5L | ||
Change from baseline to post-op (2–4 weeks) | 0.22 (0.12) | ||||
Change from post-op to follow-up (6–12 months post-surgery) | − 0.003 (0.11) | ||||
PTC patients undergoing surgery | Gou [20] | Baseline | 0.864 | SF-36 mapped to EQ-5D-3L | |
1 month post-surgery | 0.803 | ||||
6 months post-surgery | 0.870 | ||||
12 months post-surgery | 0.812 | ||||
24 months post-surgery | 0.825 | ||||
Huang [26] | 1 month post-surgery | 0.791 | SF-36 mapped to EQ-5D-3L | ||
6 months post-surgery | 0.972 | ||||
PTC patients undergoing open thyroidectomy (control group) | 1 month post-surgery | 0.676 | |||
6 months post-surgery | 0.920 | ||||
Kebebew [37] | Unilateral recurrent laryngeal nerve injury | 0.627 | Standard gamble | ||
Bilateral recurrent laryngeal nerve injury | 0.205 | ||||
Hypoparathyroidism | 0.778 | ||||
DTC recurrence | 0.54 | ||||
Lee [27] | Pre-op | 0.901 | EORTC QLQ-30 mapped to EQ-5D | ||
1 month post-surgery | 0.887 | ||||
3 months post-surgery | 0.891 | ||||
6 months post-surgery | 0.901 | ||||
PTC undergoing endoscopic thyroidectomy (experimental group) | Pre-op | 0.884 | |||
1 month post-surgery | 0.852 | ||||
3 months post-surgery | 0.887 | ||||
6 months post-surgery | 0.866 | ||||
Euthyroid | Pacini [28] | Baseline | 0.734 | SF-36 mapped to EQ-5D | |
4 week follow-up | 0.801 | ||||
Hypothyroid | Baseline | 0.692 | |||
4 week follow-up | 0.624 | ||||
Diagnostic patients | Tagay [32] | Group mean | 0.676 | SF-36 mapped to EQ-5D | |
Therapy patients | 0.718 | ||||
Inpatients | 0.794 | ||||
Outpatients | 0.705 | ||||
Drug treatments | |||||
All thyroid cancer patients | Crevenna et al. [22] | Difference from the German general population | 0.038 | SF-36 mapped to EQ-5D | |
Diagnosed within one year | 0.011 | ||||
RR-DTC | Schlumbergera
[48] SMC [50] | Sorafenib treatment effect | 0.07 | EQ-5D | |
Sorafenib arm of trial | 0.72 | ||||
BSC arm of trial | 0.8 | ||||
Tremblay [49] | Disutility from lenvatinib treatment | 0.042 | Vignette values | ||
Disutility from sorafenib treatment | 0.117 | ||||
Whole subclinical hyperthyroidism group (SCH) | Vigario [34] | Baseline | 0.578 | SF-36 mapped to EQ-5D | |
Euthyroidism group | Baseline | 0.833 | |||
SCH intervention | Baseline | 0.591 | |||
3 months post-intervention | 0.800 | ||||
SCH control | Baseline | 0.575 | |||
3 months post-intervention | 0.608 | ||||
GTC | |||||
Populations not assessed for a specific intervention | |||||
Patients with thyroid cancer | Husson [39] | Less than 5 years since diagnosis | 0.910 | EORTC QLQ-30 mapped to EQ-5D | |
Between 5 and 10 years since diagnosis | 0.902 | ||||
More than 10 years since diagnosis | 0.902 | ||||
Kung [40] | Most optimistic | 0.560 | SF-36 mapped to EQ-5D | ||
Second most optimistic | 0.494 | ||||
Third most optimistic | 0.475 | ||||
Most pessimistic | 0.450 | ||||
Roberts [41] | Whole group mean | 0.941 | EORTC QLQ-30 mapped to EQ-5D | ||
Singer [43] | Papillary | 0.835 | EORTC QLQ-30 mapped to EQ-5D | ||
Follicular | 0.824 | ||||
Medullary | 0.875 | ||||
Anaplastic | 0.958 | ||||
Tumour size 1 | 0.834 | ||||
Tumour size 2 | 0.855 | ||||
Tumour size 3 | 0.846 | ||||
Tumour size 4 | 0.757 | ||||
Lymph node metastases status 0 | 0.825 | ||||
Lymph node metastases status 1 | 0.842 | ||||
Distant metastases status 0 | 0.825 | ||||
Distant metastases status 1 | 0.850 | ||||
Men with thyroid cancer | 0.878 | ||||
Women with thyroid cancer | 0.826 | ||||
Thyroid cancer (whole group) | 0.838 | ||||
Thyroid cancer survivors | Mols [9] | Adolescents and young adults | 0.927 | EORTC QLQ-30 mapped to EQ-5D | |
Middle-aged adults | 0.897 | ||||
Elderly | 0.902 | ||||
Ryu and Hwang [53] | Patients approximately 5 years from diagnosis | 0.930 | EQ-5D | ||
RAI and surgery | |||||
Thyroid hormone withdrawal (THW) | Borget [44] | Mean at point of RAI administration | 0.833 (0.192) | EQ-5D | |
Recombinant human TSH (rhTSH) | 0.849 (0.173) | ||||
RAI 1.1 GBq | 0.836 (0.184) | ||||
RAI 3.7 GBq | 0.846 (0.182) | ||||
Drug treatments | |||||
Patients with thyroid cancer | Schroeder [42] | Baseline; receiving levothyroxine therapy | 0.542 | SF-36 mapped to EQ-5D | |
After recombinant human thyroid stimulant therapy, still on levothyroxine and on the day of the body scan | 0.544 | ||||
After thyroid hormone withdrawal but on the day of the body scan | 0.461 |