Anxiety,Depression,and Quality of Life Among Survivors of Differentiated Thyroid Cancer in Türkiye

Abstract

Objective

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy; despite excellent long-term survival, survivors often face an underrecognized psychosocial burden. This study examined how anxiety and depression relate to health-related quality of life (QoL) in DTC survivors, accounting for sociodemographic and clinical variables, to identify predictors of global health status and symptom burden.

Method

In this cross-sectional study, 518 biochemically stable DTC survivors (TSH 0.5-2.0 mIU/L) attending routine follow-up at a tertiary nuclear medicine clinic completed the Hospital Anxiety and Depression Scale (HADS) and the European Organisation for Research and Treatment of Cancer QoL Questionnaire–Core 30 (EORTC QLQ-C30).

Results

Participants (mean age 46.6 ± 11.8 years; 86% female; mean time since diagnosis 6.8 ± 4.6 years) showed high rates of depression (51%) and anxiety (26%). Women had higher anxiety/depression and lower HRQoL than men. Those with depression had higher anxiety scores, lower global health/functioning, and higher overall symptoms (all P < .001). Anxiety showed broader, more consistent inverse associations with HRQoL than depression. In multivariable linear regression, anxiety and depression were the strongest independent predictors of lower global health status and higher fatigue, whereas demographic (age, sex) and disease/treatment variables (time since diagnosis, number of radioactive iodine treatments) were not significant.

Conclusions

Psychological distress—particularly anxiety—was more strongly associated with poorer HRQoL than disease/treatment indicators in DTC survivors. Routine psychosocial screening (eg, HADS), referral to psycho-oncology, targeted fatigue management, and gender-sensitive support should be integrated into endocrine follow-up to address this hidden survivorship burden.