Symptom clusters and quality of life among patients with thyroid cancer during early survivorship: a national multicenter cross-sectional study

Abstract

Abstract Background Patients with thyroid cancer commonly experience multiple symptoms during early survivorship after thyroidectomy. However, evidence regarding symptom clusters during this period remains limited, hindering the development of targeted interventions to support recovery and improve quality of life. Objective This study aimed to explore symptom clusters among patients with thyroid cancer at 1-month postoperative follow-up and analyze their associations with quality of life. Design A national multicenter cross-sectional study. Setting and participants A total of 1093 patients with thyroid cancer from 29 hospitals in 24 provinces, municipalities, and autonomous regions in China were enrolled for this study. Participants completed the questionnaire between June and December 2024. Methods Symptom burden was assessed using the M.D. Anderson Symptom Inventory–Thyroid Cancer module, and quality of life was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Exploratory factor analysis was used to identify symptom clusters. Mann–Whitney U tests and Kruskal–Wallis H tests were performed to examine differences in quality of life across demographic and clinical characteristics. Multiple linear regression analysis was conducted to identify factors associated with quality of life. Results Three symptom clusters were identified during early survivorship following thyroidectomy: a psychological-somatic symptom cluster, a thyroid hormone-related symptom cluster, and a surgery-related symptom cluster. In the multiple linear regression model, all 3 symptom clusters were independently associated with poorer quality of life, with the psychological-somatic symptom cluster showing the strongest association (β = −0.596, 95% CI, −0.713, −0.581). Female sex (β = −0.051, 95% CI, −2.795, −0.253) and total thyroidectomy (β = −0.058, 95% CI, −2.746, −0.390) were also independently associated with poorer quality of life. Conclusions Symptom clusters are prevalent among patients with thyroid cancer during early survivorship and are significantly associated with poorer quality of life. The psychological-somatic symptom cluster showed the strongest association, while female patients and those undergoing total thyroidectomy may be at increased risk for poorer quality of life. Early identification of symptom clusters and vulnerable patient groups may facilitate more targeted postoperative assessment and supportive management.