Introduction
Thyroid cancer diagnosis is often accompanied by strong negative emotions, such as fear and anxiety, but little is known about these emotions in patients with benign thyroid nodules. This study examined the effect of a hypothetical cancer diagnosis, treatment information provision, and emotional support by surgeons on patients with a benign thyroid nodule.
Methods
Patients <30-days after a benign thyroid nodule biopsy were asked to imagine their biopsy was thyroid cancer and write down their feelings about this diagnosis. Participants then watched a video depicting a patient-surgeon discussion of thyroid cancer treatment options with or without added emotional support from the surgeon (1:1 allocation). Validated measures assessed state anxiety and thyroid cancer-related fear at baseline and after watching the video. Thematic analysis evaluated participants’ feelings about their hypothetical diagnosis. T-tests and Pearson chi-squared were used to analyze quantitative measures. All participants were debriefed at the end of the study to ensure they knew their thyroid nodule was not cancerous.
Results
Of 208 eligible patients, 118 participated (56.7%). Most participants were female (85.6%), White (88.1%), and had a thyroid nodule measuring ≤3 cm (62.7%). Overall, 68.4% had bilateral nodules, and 18.6% reported symptoms. Less than a quarter of participants (22.9%) thought they were more likely to get thyroid cancer than the average person. Participants had significantly higher state anxiety after performing the thought exercise and watching the video (9.1 (3.2) vs. 11.5 (4.0), p<0.001). However, thyroid cancer-related fear decreased over the same time period (26.5 (6.3) vs. 24.8 (7.0), p<0.001). Added emotional support by the surgeon in the video did not affect participants' level of anxiety or fear. Themes from participants imagining they have thyroid cancer and exemplary quotes are shown in the Table. Emotions described by participants were predominantly negative.
Conclusion
This study demonstrates that patients with benign thyroid nodules experience increased anxiety when thinking about having thyroid cancer. Provision of treatment-related information from a surgeon, but not emotional support, decreases their cancer-related fear. Patients with benign thyroid nodules may benefit emotionally from being provided with information about thyroid cancer prior to or at the time of their biopsy.
| Themes | Exemplary Quotes |
| Information Seeking | “I would feel sick to my stomach and want to get my hands on as much information as I could to figure out a treatment plan.” |
| Trust in Medicine | “I would have been upset, but know that I was in good hands. It would also depend on how bad it was.” |
| Personal Experience of Cancer | “I would be very concerned, I just underwent treatment for breast cancer, I would be afraid of the cancer affecting other organs or bones.” |
| Knowledge of Positive Prognosis | “I read and was told this type of cancer is curable, so I would not overreact like I thought I was in an end-of-life situation. Unhappy is the thought that comes to mind.” |
| Apprehension about Surgery | “I would feel panic about the physical surgery process itself, the recovery and consequences of surgery, and the financial burden of surgery.” |
| Impact on Family | “I would have been concerned about future treatment and care. I would have been worried about how this would affect my life and the activities I love and the people I have responsibility for.” |