Inaccurate Risk Perceptions Lead to Worry and Decreased QOL in Patients with Thyroid Cancer

Less educated patients and Hispanic patients with low-risk thyroid cancer were more likely to report inaccurate risk perceptions, which were associated with worry and a decreased quality of life, according to a study published in Cancer. 

These data indicate that patient education that is suitable for individuals of differing educational levels and culturally sensitive, and improved risk communication by physicians, are needed to address inaccurate risk perceptions. 

“Effective communication and appropriate reassurance by physicians may help patients to create a framework for understanding their cancer prognosis so that they can make informed treatment decisions and adequately cope with the psychosocial stress related to having a cancer diagnosis,” the authors wrote. 

A cohort of 1,597 patients with low risk differentiated thyroid cancer (DTC) was formed using patients identified through the SEER registries of Georgia and Los Angeles County. Of this study sample, 24.7% of the participants overestimated their recurrence risk and 12.5% overestimated their mortality risk. Worry about recurrence and death was shown to be greater among patients who overestimated versus those who had a fairly accurate estimate of their risk of disease recurrence and mortality, respectively (P < 0.001). Patients who overestimated mortality risk also reported a decreased physical quality of life (mean T score, 43.1; 95% CI, 41.6-44.7) compared with the general population.

Furthermore, a lower educational level was correlated with overestimating disease recurrence (≤high school diploma: odds ratio [OR], 1.64 [95% CI, 1.16-2.31]; and some college: OR 1.36 [95% CI, 1.02-1.81]) and mortality (≤high school diploma: OR, 1.86 [95% CI, 1.18-2.93]) risk compared to those attaining at least a college degree. Hispanic ethnicity was also found to be associated with overestimating recurrence risk (OR, 1.44; 95% CI, 1.02-2.03) compared with their white counterparts.

“Improving psychosocial support, including the availability of online websites and in-person support groups, for patients with thyroid cancer-related worry also is imperative,” the authors wrote. 

The authors indicated that further research is necessary to highlight the relationship between risk estimates and worry, given that the causality between these 2 variables is currently unknown. Additionally, given that this cohort only included patients from 2 geographic areas, this study may not be representative of all patients with thyroid cancer; though the SEER population is comparable to the general US population. 

Patients were not asked about the resources they used to learn about thyroid cancer or their ease in communicating with physicians, both of which could have had an influence on their risk perception. Moreover, the study did not evaluate health literacy and numeracy or determine acculturation among Hispanic patients, which could have provided more insight into this population’s risk overestimations. 

Regardless of the limitations however, the study implications are relevant to patients and physicians given that interventions in these unique populations may translate into an improved quality of life for survivors of thyroid cancer. 

Reference:

Chen DW, Reyes-Gastelum D, Wallner LP, et al. Disparities in Risk Perception of Thyroid Cancer Recurrence and Death. Cancer. doi:10.1002/cncr.32670.