Development of the ThyCAT: A clinically useful computerized adaptive test to assess quality of life in thyroid cancer survivors

doi:10.1016/j.surg.2017.09.009

Surgery

Volume 163, Issue 1, January 2018, Pages 137-142

https://doi.org/10.1016/j.surg.2017.09.009 Get rights and content

Abstract

Background

Current quality of life assessment tools for thyroid cancer survivors are not clinically useful due to the length of available questionnaires. Computerized adaptive tests are easily administered electronically and can achieve highly accurate and efficient results in minimal time. We aimed to develop a quality of life computerized adaptive tests (ThyCAT) for thyroid cancer survivors.

Methods

A bifactor item response theory model was fit to questionnaire responses from 1,078 North American Thyroid Cancer Survivorship Study participants—a longitudinal cohort study of quality of life in thyroid cancer survivors. Tuning parameters were selected to maintain a correlation of r > 0.9 with the total item bank quality of life score obtained from the original North American Thyroid Cancer Survivorship Study questions, using a minimal number of adaptively administered ThyCAT items.

Results

The ThyCAT assesses quality of life with strong correlation (r = 0.96) with the original 75 North American Thyroid Cancer Survivorship Study questions using an average of 9.94 questions (SD ± 3.03) administered in <2 minutes. There was no statistically significant difference in the number of ThyCAT questions required based on demographic or tumor characteristics.

Conclusion

The ThyCAT can be administered on a smartphone app in <10 questions, and <2 minutes, allowing efficient and accurate in or out of clinic identification of patients struggling with quality of life issues after thyroid cancer treatment.

Section snippets

The bifactor model

Quality of life is a multidimensional phenomenon; the metric utilized in the NATCSS survey, for instance, samples quality of life items from physical, psychologic, social, and spiritual domains. Items sampled from the subdomains produce residual associations between items within the subdomains unaccounted for in the primary dimension (here, quality of life) on which most applications of item response theory and unidimensional models are based.14, 15 Bifactor item response theory models permit

Bifactor model

The fit of the bifactor model to the observed data is illustrated in Fig. Fig reveals strong agreement between the item-category proportions based on the model and the observed data (r = 0.963). Of the original 75 items in the QOL survey, 58 items were selected for the CAT item bank based on the 0.35 primary factor loading criterion (Table II). The items included in each subdomain are illustrated there as well, with the largest number of questions (N = 29) belonging to the physical subdomain,

Discussion

Although thyroid cancer prognoses are good (the 10-year survival for the predominant type, papillary, is as high as 97%), the initial findings of the NATCSS study point to long-term and late psychosocial effects after completion of primary treatment requiring coordinated follow-up.³ The surprise of these findings suggesting QoL comparable with cancers of much poorer prognosis⁴ illustrates how poorly understood long-term thyroid cancer survivorship currently is. This problem will continue to

Acknowledgments

Study data were collected and managed using REDCap electronic data capture tools hosted at The University of Chicago. REDCap (Research Electronic Data Capture) is a secure, Web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for

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Cited by (8)

Quality of life in thyroid cancer
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To explore the impact of differentiated thyroid cancer (DTC) on quality of life (QoL) a clinical analytical framework was developed. Based on the clinical analytical framework, a systematic literature search was performed to identify studies applying patient-reported outcomes (PRO) instruments among patients with DTC. Subsequently, the scope was narrowed down to studies comparing scores on the Medical Outcomes Study (MOS) Short form 36 (SF-36) to a reference population (clinical interpretability criterion).
Further, the currently available thyroid cancer (TC) specific QoL PROs were review in accordance with the standards of the International Society of Quality of Life Research.
In the initial search, 213 studies were included. The additional ‘clinical interpretability’-criteria, limited the final study sample to 16 studies, 13 cross-sectional and 3 longitudinal. QoL was impacted across all SF-36 scales. The impact was generally modest and the impact was impeded by time since diagnosis and treatment.
Four TC specific instruments were identified. Generally, the documentation of their measurement properties, particularly content validity and clinical validity, including substantial quantitative validation, was scarce. As was the cross-cultural applicability of the currently available instruments.
This restricted, focused, clinically founded review showed an impact on a broad range of QoL issues. There is a need for large-scale measurement of QoL outcome longitudinally, using well-validated PRO instruments in order to identify with certainty the impact on subgroups.
Changes in total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer during the past 15 years
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Citation Excerpt :
However, the use of radioactive iodine has not been substantiated in small, nonaggressive PTCs.27–30 Along with the considerable data showing equivalency in outcomes with less aggressive surgery, there have also been several studies showing significant quality of life effects associated with the treatment of thyroid cancer, primarily thyroidectomy and radioiodine ablation, suggesting a true detrimental effect of overtreating these less aggressive thyroid cancers.15,16,31–33 As a result of the growing body of literature suggesting overdiagnosis and overtreatment of nonaggressive PTCs, a substantial shift in the recommendations for the surgical treatment have occurred during the past 12 years.
The incidence of papillary thyroid cancer has increased substantially during the past 15 years, which is likely related to an increased detection of small, nonlethal cancers. Studies have shown that patients may have a similar prognosis when undergoing less aggressive surgical intervention, such as thyroid lobectomy. The objective of this study is to determine whether surgical treatment patterns for papillary thyroid cancer have changed during the past 15 years.
We performed a retrospective cohort study evaluating changes in the incidence and proportion of total thyroidectomy versus thyroid lobectomy for histologically confirmed papillary thyroid cancers, using the National Cancer Institute Surveillance, Epidemiology, and End Results cancer registries between 2000 and 2014.
During the study period, 44,537 patients underwent surgical treatment for papillary thyroid cancer, of which 77% were female and 81.3% were white. The incidence of papillary thyroid cancer more than doubled: from 6.2 (5.9–6.5) to 13.0 (12.5–13.4) per 100,000. The proportion of total thyroidectomy among all papillary cases increased from 78.16% in 2000 to 85.67% in 2014, and the proportion of thyroid lobectomy dropped from 16.62% to 11.41%. When stratified by tumor size, we observed a sustained and increasing gap in the proportions of total thyroidectomy and thyroid lobectomy.
The incidence of total thyroidectomy has not decreased despite recommendations encouraging consideration of lobectomy for patients with small papillary thyroid cancers. Although these findings could be attributed to the lag between scientific evidence and clinical practice, further work is warranted to explore any additional patient and provider factors that may explain this lack of change.
Quality of Life in Head & Neck Surgical Oncology and Thyroid Surgery
2023, Patient Reported Outcomes and Quality of Life in Surgery
Thyroid disease-specific quality of life questionnaires - A systematic review
2022, Endocrinology, Diabetes and Metabolism
Systematic review of health-related quality of life following thyroid cancer
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Looking under the hood of “the Cadillac of cancers:” radioactive iodine-related craniofacial side effects among patients with thyroid cancer
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: Supported by the National Institutes of Health for A New Statistical Paradigm for Measuring Psychopathology Dimensions in Youth (Grant #: 1R01MH100155-01).

: Raymon H. Grogan, MD, was supported in part by the University of Chicago Bucksbaum Institute for Clinical Excellence.

: Robert Gibbons, PhD, is a founder of Adaptive Testing Technologies, a company that distributes computerized adaptive tests. The terms of this arrangement have been reviewed and approved by the University of Chicago in accordance with its conflict of interest policies. The other authors reported no biomedical financial interests or potential conflicts of interest.

: Presented at the 38th Annual Meeting of the American Association of Endocrine Surgeons, Orlando, FL, April 2–4, 2017.

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ThyroidDevelopment of the ThyCAT: A clinically useful computerized adaptive test to assess quality of life in thyroid cancer survivors

Abstract

Background

Methods

Results

Conclusion

Section snippets

The bifactor model

Bifactor model

Discussion

Acknowledgments

The clinical and economic burden of a sustained increase in thyroid cancer incidence

Cancer Epidemiol Biomarkers Prev

Risk factors for decreased quality of life in thyroid cancer survivors: initial findings from the north american thyroid cancer survivorship study

Thyroid

Quality of life in thyroid cancer is similar to that of other cancers with worse survival

World J Surg

From Cancer Patient to Cancer Survivor: Lost in Transition

Integrated care pathways for cancer survivors-a role for patient-reported outcome measures and health informatics

Acta Oncol

Assessing quality of life in long-term cancer survivors: a review of available tools

Support Care Cancer

Using computerized adaptive testing to reduce the burden of mental health assessment

Psychiatr Serv

Development of a computerized adaptive test for depression

Arch Gen Psychiatry

Computerized adaptive diagnosis and testing of mental health disorders

Annu Rev Clin Psychol

Thyroid
Development of the ThyCAT: A clinically useful computerized adaptive test to assess quality of life in thyroid cancer survivors