13. Psychosocial aspects – Thyroid Cancer
Patients shall be adequately informed about the diagnosis and general prognosis. They shall be advised on the therapeutic options based on the individual findings, the prognosis, taking into account psychosocial aspects and quality of life. They shall have the opportunity to involve other people in the informative discussion.
- Consensus
- Strong consensus (100%)
As a cancer diagnosis is accompanied by a great deal of uncertainty and treatment can have far-reaching consequences, it is necessary to inform patients about all relevant points and give them the opportunity to ask questions. Patients shall have the feeling that they are involved in their medical decisions. If patients feel involved in the decision (shared decision making), this can have a positive effect on treatment-relevant outcomes [1311], [1312], [1313], [1314].
Studies [1315], [1316], [1317] have shown that thyroid cancer patients want more information in the areas of diagnosis, treatment and aftercare. These needs should be addressed and adequately addressed in educational discussions.
As the topic of thyroid cancer is stressful and patients have a multitude of thoughts and questions after diagnosis [1315], [1316], [1318], [1319], [1320], the participation of another person in the educational talks can help here.
The individual preferences, needs, concerns and fears of the patient shall be elicited and taken into account during the medical consultation. If a patient requires several consultations, the offer shall consist of further consultations.
- Consensus
- Strong consensus (100%)
With the diagnosis of thyroid cancer and during the course of treatment, patients experience fears and worries [1321], [1318], [1319], [1320]. The diagnosis of thyroid cancer also has an impact on patients' everyday lives and future plans [1316], [1317], [1322].
These must be taken into account during the medical consultation. If worries and fears are not adequately addressed, this can lead to poorer outcomes. This has been shown in studies of other cancer entities [1323], [1324], [1325].
Studies [1315], [1316], [1317] have shown that thyroid cancer patients report a high need for information in various areas (diagnosis, treatment, aftercare, psychological support, etc.). These individual needs and preferences should be taken into account in the medical consultation.
All patients with thyroid cancer shall be offered screening for psychosocial stress using a validated and standardized instrument.
- Consensus
- Consent (81%)
Psycho-oncological screening should be carried out as early as possible at appropriate intervals if clinically indicated or repeatedly during the course of the disease if a patient's disease status changes (e.g. recurrence or progression of the disease).
(Guideline adaptation S3 guideline psycho-oncology, version 2022)
- Consensus
- Strong consensus (100%)
Screening for psychosocial stress and clarification of support needs shall be carried out on a voluntary basis.
Depending on local circumstances, screening for psychosocial distress can be carried out by any member of the treatment team responsible for the care of cancer patients after appropriate training.
The best national and international evidence for cancer patients is available for the Distress Thermometer (DT), the Hospital Anxiety and Depression Scale (HADS-D), the depression module of the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) module. In German-speaking countries, the questionnaire on stress in cancer patients (FBK-23 and FBK-10) is also well validated (Evidence-based Guideline Psycho-oncological Diagnostics, Counseling and Treatment of Adult Cancer Patients).
Only diagnostic procedures that fulfill the psychometric quality criteria (objectivity, reliability and validity) shall be used in psycho-oncological screening. Practicability, even for patients with severe cancer, and cost-effectiveness are further important requirements. In addition to the aforementioned quality criteria, empirically determined cut-off values should be available for screening procedures that also demonstrate satisfactory sensitivity and specificity. As part of the aforementioned S3 guideline on psycho-oncology, a detailed evaluation of the psychometric quality criteria was carried out on the basis of a systematic literature search of publications relating to German patients.
A study by Loth et al. [1326] showed that systematic psycho-oncological screening leads to increased identification of patients with psycho-oncological needs.
All of the above-mentioned questionnaires have already been used in a large number of studies with patients with thyroid cancer [1321], [1327].
Thyroid cancer patients can experience psychosocial limitations and a reduction in quality of life at any point during the course of the disease and treatment [944], [1328], [1329], [1321], [1158], [1330], [1327]. Despite the relatively good prognosis of thyroid cancer, patients have quality of life impairments that are comparable to those of patients with other cancers with a poorer prognosis [1331].
Furthermore, thyroid cancer patients would like to receive more information on psychosocial counseling, and patients see a major lack of information in this area [1315], [1316]. Dionisi-Vici et al. [1332] were able to show that half of long-term survivors of thyroid cancer complain of unmet psychological needs.
If the screening is positive and/or there is a subjective need for support, a diagnostic interview shall be offered to clarify psychosocial stress, psychological comorbidities and the need for support and treatment.
(Guideline adaptation S3 guideline psycho-oncology, version 2022)
- Consensus
- Strong consensus (95,7%)
Patients with diagnosed mental disorders shall be treated in accordance with the existing disorder-specific guidelines.
(Guideline adaptation S3 guideline psycho-oncology, version 2022)
- Consensus
- Strong consensus (100%)
A large number of studies in thyroid cancer patients show positive screening results using the above-mentioned instruments. Positive screening results can be seen over the entire course of the disease up to long-term survivors [1333], [1334], [1321], [1317]. In a study of 640 German thyroid cancer survivors, Noto et al. [1335] reported that 37.6% exceeded the cut-off value for anxiety disorders and 15.7% for depression, measured using the HADS.
If a mental disorder worthy of treatment is diagnosed during the diagnostic interview, the corresponding German-language S3 guidelines are applied. An overview of these guidelines can be found in Table 9 of the guideline on ‘Psycho-oncology’.
Furthermore, special interventions tailored to thyroid cancer patients have shown success [1336], [1337], [1338],[1339]. Interventions should also be adapted to the individual needs of the patient. For example, Husson et al. [1340] were able to show that age can have an influence on psychological stress and the perception of illness in thyroid cancer patients.
References
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