Patient‑reported outcome measures for assessing health‑related quality of life in patients with differentiated thyroid cancer: a systematic review

Abstract

Background
Patient-reported outcome measures (PROMs) have become important tools for evaluating health-related quality of life (HRQOL) in patients with differentiated thyroid cancer (DTC). While there are many PROMs available to measure HRQOL, there is a lack of a comprehensive overview of these PROMs. Therefore, we aimed to systematically review and categorize all PROMs that have been used to measure HRQOL in patients with DTC.

Materials and methods
After determining the search strategy and identifying inclusion and exclusion criteria, articles were searched in PubMed and EMBASE from January 1900 to September 2023. Information on PROMs from the included studies, such as development language, target population, (sub)scales name, number of items per (sub)scale, completion time, and validation, was extracted and synthesized. The frequency with which PROMs were utilized in the included studies was also graphed. After innovatively classifying PROMs as five categories, all of the included PROMs were allocated to their respective categories.

Results
A total of 330 articles fulfilled all of the criteria, and they utilized 96 different PROMs to measure HRQOL in DTC patients. The 96 PROMs were classified into five categories, namely universal PROMs (16/96), DTC-related PROMs (11/96), radioiodine-related PROMs (4/96), operation-related PROMs (37/96), and psychology-related PROMs (28/96). Among them, some PROMs were the frequently employed PROMs to assess diverse aspects of HRQOL in patients with DTC.

Conclusion
A large number of PROMs are available for patients with DTC, which evaluate all aspects of HRQOL. Combining the relevant information and frequency of PROMs utilization, it can provide convenience and reference for researchers to select PROMs across different categories. However, a more detailed critical appraisal of the PROMs used in various clinical scenarios is required. Additionally, PROMs usage frequency in previous studies can indirectly indicate the comprehensiveness or gaps in HRQOL aspects studied, guiding further review or research.

Full text

Patient‑reported outcome measures for assessing
health‑related quality of life in patients with
differentiated thyroid cancer: a systematic review
Lujing Xiong, MDa,b, Lei Liu, MDa,b, Yuqing Xiang, MDb,c, Chao Li, PhDb,*, Wei Dai, PhDd, Jinchuan Hu, MDb,c,
Chunyan Shui, MDb, Yuqiu Zhou, MDb, Xu Wang, MDb, Yongcong Cai, PhDa,b,*
Background: Patient-reported outcome measures (PROMs) have become important tools for evaluating health-related quality of
life (HRQOL) in patients with differentiated thyroid cancer (DTC). While there are many PROMs available to measure HRQOL, there is
a lack of a comprehensive overview of these PROMs. Therefore, the authors aimed to systematically review and categorize all
PROMs that have been used to measure HRQOL in patients with DTC.
Materials and methods: After determining the search strategy and identifying inclusion and exclusion criteria, articles were
searched in PubMed and EMBASE from January 1900 to September 2023. Information on PROMs from the included studies, such
as development language, target population, (sub)scales name, number of items per (sub)scale, completion time, and validation, was
extracted and synthesized. The frequency with which PROMs were utilized in the included studies was also graphed. After
innovatively classifying PROMs as five categories, all of the included PROMs were allocated to their respective categories.
Results: A total of 330 articles fulfilled all of the criteria, and they utilized 96 different PROMs to measure HRQOL in DTC patients.
The 96 PROMs were classified into five categories, namely universal PROMs (16/96), DTC-related PROMs (11/96), radioiodine-
related PROMs (4/96), operation-related PROMs (37/96), and psychology-related PROMs (28/96). Among them, some PROMs
were the frequently employed PROMs to assess diverse aspects of HRQOL in patients with DTC.
Conclusion: A large number of PROMs are available for patients with DTC, which evaluate all aspects of HRQOL. Combining the
relevant information and frequency of PROMs utilization, it can provide convenience and reference for researchers to select PROMs
across different categories. However, a more detailed critical appraisal of the PROMs used in various clinical scenarios is required.
Additionally, PROMs usage frequency in previous studies can indirectly indicate the comprehensiveness or gaps in HRQOL aspects
studied, guiding further review or research.
Keywords: HRQOL, PROMs, questionnaires, scales, thyroid cancer
Introduction
In recent years, the incidence of thyroid cancer (TC) has been
increasing, with 43 720 new cases of TC in the United States and
202 600 new cases in China per year, ranking the seventh in the
United States and the second in China among all malignant
tumors in female
[1,2]
. Differentiated thyroid cancer (DTC) is the
most common type of TC
[3]
. The main treatment for DTC is
surgery, and the 10-year survival rate of postoperative patients is
as high as 90–95%
[4]
. For better good prognosis of patients with
DTC, more attention should be paid to achieving better post-
operative health-related quality of life (HRQOL). HRQOL is a
multidimensional concept including impacts of the disease on
physical, psychological, social, spiritual well-being
[5]
, which
could be measured by patient-reported outcomes (PROs). PROs
a
School of Medicine, University of Electronic Science and Technology of China,
b
Department of Head and Neck Surgery, Sichuan Clinical Research Center for Cancer, Sichuan
Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China,
c
Graduate School of Chengdu
Medical College and
d
Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institut e, Sichuan Cancer Center, Affiliated
Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
*Corresponding author. Address: Department of Head and Neck Surgery, Sichuan Clinical Research Center for Cancer, SichuanCancer Hospi tal and Institute, Sichuan Cancer
Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, No.55, Section 4, Renmin South Road, Chengdu, Sichuan 610041, People’s
Republic of China. Tel.: +181 233 82056. E-mail: caiyongcong@scszlyy.org.cn (Y. Cai), and Tel.: +135 412 33090. E-mail: lichao@scszlyy.org.cn (Chao Li).
Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website,
www.lww.com/international-journal-of-surgery.
Published online 19 July 2024
Received 4 June 2024; Accepted 8 July 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-
NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
International Journal of Surgery (2025) 111:1311–1329
http://dx.doi.org/10.1097/JS9.0000000000001974
’
Systematic Review and/or Meta-analysis
1311

could measure any aspect of patients’health status directly
reported by the patients including HRQOL
[6]
, which is more
sensitive, reliable, comprehensive than that evaluated by
clinical staff.
Patient-reported outcome measures (PROMs) directly collect
patients’information on health outcomes in the form of stan-
dardized questionnaires. Thus far, PROMs have been increas-
ingly used as primary outcome measures for research and clinical
decision-making. There are a number of PROMs available to
measure HRQOL in patients with TC, as reviewed in previous
literature
[7–9]
. However, some of these reviews have included
studies in patients with benign thyroid disease
[8,9]
. Given the
different treatments for benign thyroid disease and TC as well as
different prognosis, PROMs for the two populations may be
different. In addition, a review by Roth et al.
[7]
aimed to identify
HRQOL instruments in a TC population, and present the psy-
chometric properties of these questionnaires. However, Roth
et al. only described generic, cancer-specific, and TC-specific
PROMs, but did not review PROMs related to postoperative
symptoms and radioiodine-induced symptoms of TC patients,
which are also an important part of HRQOL.
Previous studies have shown that most postoperative TC
patients have symptoms, such as voice change
[10]
, neck and
shoulder discomfort
[11]
, etc., and psychological problems
[12]
,
such as anxiety, depression, and stress, and most patients after
radioiodine therapy experience xerostomia
[13]
, and all these
issues can affect patients’HRQOL. Therefore, to measure the
effect of postoperative symptoms, psychological problems, and
symptoms after radioiodine therapy on HRQOL, various
PROMs have emerged
[11,14–16]
. However, these PROMs have
not been reviewed in previous studies, and frequencies with which
different PROMs were applied in previous studies have not been
described. Generally, PROMs are categorized as generic and
disease-specific or condition-specific. However, to better
HIGHLIGHTS
•A large number of patient-reported outcome measures
(PROMs) that evaluate all aspects of health-related quality
of life are available for patients with differentiated thyroid
cancer (DTC).
•This review first described the frequency with which
PROMs were utilized for measuring the health-related
quality of life of DTC patients in previous studies.
•The 96 PROMs were innovatively classified into five
categories, namely universal PROMs, DTC-related
PROMs, radioiodine-related PROMs, operation-related
PROMs, and psychology-related PROMs.
•Combining the relevant information and frequency of
PROMs utilization, it can provide convenience and refer-
ence for researchers to select PROMs across different
categories.
Figure 1. PRISMA flowchart of study selection.
Xiong et al. International Journal of Surgery (2025) International Journal of Surgery
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Table 1
Characteristics of the included universal PROMs for DTC.
PROMs
Development
language
Target
population Names of (sub)Scales
Number of items per
(sub)Scales
Completion
time Validation Comments
SF-36 English General
population
1. Physical functioning
2. Social functioning
3. Role-physical
4. Role-emotional
5. Mental health
6. Vitality
7. Pain
8. General health
9. Reported health transition
1. 10 items
2. 2 items
3. 4 items
4. 3 items
5. 5 items
6. 4 items
7. 2 items
8. 5 items
9. 1 item
36 items in total
10–15 min Yes NA
EORTC QLQ-C30 English Cancer patients Global health scale
Functional scales
1. Physical
2. Role
3. Emotional
4. Cognitive
5. Social
Symptom scales
1. Fatigue
2. Nausea
3. Pain
4. Dyspnea
5. Insomnia
6. Appetite
7. Constipation
8. Diarrhea
Financial scale
Global health scale
2 items
Functional scales
1. 5 items
2. 2 items
3. 4 items
4. 2 items
5. 2 items
Symptom scales
1. 3 items
2. 2 items
3. 2 items
4. 1 item
5. 1 item
6. 1 item
7. 1 item
8. 1 item
Financial scale
1 item
30 items in total
About 9 min
(range
7–15 min)
Yes NA
SF-12 English General
population
1. Physical functioning
2. Social functioning
3. Role-physical
4. Role-emotional
5. Mental health
6. Vitality
7. Pain
8. General health
1. 2 items
2. 1 item
3. 2 items
4. 2 items
5. 2 items
6. 1 item
7. 1 item
8. 1 item
12 items in total
3–4 min Yes NA
EQ-5D English
Dutch
Finnish
Norwegian
Swedish
General
population
EQ-5D descriptive system
1. Mobility
2. Self-care
3. Usual activities
4. Pain/discomfort
5. Anxiety/depression
EQ-5D VAS
EQ-5D descriptive system
1 item per subscale
EQ-5D VAS
1 item
6 items in total
<3 min Yes Generic healthy utility measures.
PROMIS-29 English General
population
1. Anxiety
2. Depression
3. Fatigue
4. Pain interference
5. Physical functioning
6. Sleep disturbance
7. Social functioning
8. Pain intensity
1. 4 items
2. 4 items
3. 4 items
4. 4 items
5. 4 items
6. 4 items
7. 4 items
8. 1 item
29 items in total
5.4 ±3.0 min Yes T-scores allow the comparison of
PROs across a variety of chronic
diseases within general
population.
WHOQOL-BREF English
Croatian
French
Hebrew
Japanese
Dutch
General
population
1. General QOL
2. General health
3. Physical health
4. Psychological
5. Social relationships
6. Environment
1. 1 item
2. 1 item
3. 7 items
4. 6 items
5. 3 items
<5 min Yes NA
Xiong et al. International Journal of Surgery (2025)
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Table 1
(Continued)
PROMs
Development
language
Target
population Names of (sub)Scales
Number of items per
(sub)Scales
Completion
time Validation Comments
Spanish
Russian
Thai
6. 8 items
26 items in total
FACT-G English Cancer patients 1. Physical well-being
2. Social/family well-being
3. Emotional well-being
4. Functional well-being
1. 7 items
2. 7 items
3. 6 items
4. 7 items
27 items in total
5–10 min Yes NA
SF-6D English General
population
1. Physical functioning
2. Role limitations
3. Social functioning
4. Pain
5. Mental health
6. Vitality
14 items in total NR Yes Generic healthy utility measures.
PedsQL English Children aged
5–12 year or
teenagers
aged
13–18 year
1. Physical
2. Emotional
3. Social
4. School
1. 8 items
2. 5 items
3. 5 items
4. 5 items
23 items in total
<4 min Yes Can be used to assess quality of
life in pediatric population with
DTC.
SOMS-7 English Patients with
somatoform
disorders
All somatic symptoms
mentioned as occurring in
somatization disorder
53 items in total <15 min Yes NA
IPAQ-7 English Adults aged
15–69 year
1. Occupational
2. Transport
3. Household and Garden
4. Leisure
5. Sitting
6. Sleep
1. 7 items
2. 6 items
3. 4 items
4. 6 items
5. 2 items
6. 2 items
27 items in total
About 5 min Yes NA
MDASI English Cancer patients 1. Symptoms
2. Symptom interference
1. 13 items
2. 6 items
19 items in total
<5 min Yes NA
HUI2 English General
population
1. Sensation
2. Mobility
3. Emotion
4. Cognition
5. Self-care
6. Pain
15 items in total 5–10 min Yes NA
HUI3 English General
population
1. Vision
2. Hearing
3. Speech
4. Ambulation
5. Dexterity
6. Emotion
7. Cognition
8. Pain
12 items in total 5–10 min Yes NA
15D Finnish General
population
1. Breathing
2. Mental function
3. Speech
4. Vision
5. Mobility
6. Usual activities
7. Vitality
8. Hearing
9. Eating
10. Elimination
11. Sleeping
12. Distress
13. Discomfort and Symptoms
14. Sexual activity
15. Depression
1 item per scale
15 items in total
5–10 min Yes NA
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distinguish the range measured by different PROMs, so that
clinical researchers can better select appropriate PROMs, we
innovatively divided PROMs into five categories, which has not
been done in the previous reviews. Because of these research gaps,
we aimed to systematically review and categorize all PROMs that
have been applied to measure HRQOL in patients with DTC.
Methods
This systematic review was conducted in accordance with the
Preferred Reporting Items for Systematic Reviews and Meta-
Analysis (PRISMA, Supplemental Digital Content 1, http://links.
lww.com/JS9/D117, Supplemental Digital Content 2, http://links.
lww.com/JS9/D118) statement
[17]
and was guided by the
Assessing the Methodological quality of Systematic Reviews
(AMSTAR, Supplemental Digital Content 3, http://links.lww.
com/JS9/D119) guidelines
[18]
for methodological quality. The
protocol was registered in the PROSPERO database.
Search strategy
Articles were searched in PubMed and EMBASE from January
1900 to September 2023. Two researchers (C.Y.C. and L.C.) had
jointly determined the search terms, which mainly centered
around two aspects, namely ‘thyroid cancer’and ‘patient-repor-
ted outcome measures’or ‘questionnaires’or ‘scales’or ‘quality
of life’or ‘health-related quality of life’.
Study selection
To be considered, the studies needed to meet the inclusion criteria.
The inclusion criteria were as follows: 1) articles were limited to
patients with TC; 2) authors developed and named a PROM to
evaluate HRQOL for TC population; 3) original articles utilized
questionnaires to assess TC-related HRQOL; 4) the ques-
tionnaires contained in the articles were completed by patients; 5)
articles were published in English; 6) full-text version of articles
was available online. The exclusion criteria were as follows: 1)
articles including patients with anaplastic or medullary TC; 2) the
PROM was used as a comparison tool in a validation study of
another tool; 3) review articles, conference abstracts, case reports,
and articles without abstracts; 3) PROMs assessing environment
characteristics, such as social or financial support, behavior
characteristics, such as eating or working behavior; 4) patient-
reported experience measures (PREMs), such as disease accep-
tance, illness perception, or treatment satisfaction. Based on these
eligibility criteria, the title and abstract and the full-text of the
articles were screened independently by two groups of researchers
(X.L.J., L.L., X.Y.Q., H.J.C., S.C.Y., and W.X.). From the iden-
tified studies reference lists, additional eligible articles were
checked by the researchers (L.L. or Z.Y.Q.). If there was dis-
agreement between two researchers, the opinion of a third
researcher (D.W.) was sought to reach consensus.
Data extraction and synthesis
Information on PROMs from the included studies, such as name,
development language, target population, (sub)scale name,
number of items per (sub)scale, completion time, and validation
(validity and reliability of PROMs in different populations at
least), was extracted and analyzed by two groups of researchers
(X.L.J., L.L., X.Y.Q., H.J.C., S.C.Y., and Z.Y.Q.). The frequency
with which PROMs were utilized in the included studies was also
summarized. Based on the fact that PROMs were categorized as
generic and disease-specific or condition-specific, we further
refined the categories of the PROMs utilized in DTC patients.
First, the category of generic PROMs was retained. Second, the
category of disease-specific PROMs was changed to DTC-related
PROMs. Third, based on the factors affecting DTC patients’
HRQOL, the category of condition-specific PROMs was further
refined to the following categories: operation-related PROMs,
radioiodine-related PROMs, and psychology-related PROMs.
According to the category criteria, the researchers (L.L., X.Y.Q.,
H.J.C., S.C.Y., Z.Y.Q., and W.X.) divided the different PROMs
into five categories. If there was disagreement between two
researchers, a third researcher (D.W.) was consulted to reach
consensus. If relevant information on PROMs was not found in
the included studies, the researchers searched for it in PubMed,
Google, or other resources.
Category criteria:
1. Target population. For example, PROMs for general popula-
tion and cancer population were generally categorized into
universal PROMs; PROMs for TC population and head-and-
neck cancer (including TC) population were generally cate-
gorized into DTC-related PROMs; PROMs for patients with
different symptoms were generally categorized into operation/
radioiodine-related PROMs; PROMs for emotional disorders
were generally categorized into psychology-related PROMs.
Table 1
(Continued)
PROMs
Development
language
Target
population Names of (sub)Scales
Number of items per
(sub)Scales
Completion
time Validation Comments
NHP English General
population
1. Energy
2. Pain
3. Emotional
4. Sleep
5. Social
6. Mobility
1. 3 items
2. 8 items
3. 9 items
4. 5 items
5. 5 items
6. 8 items
38 items in total
About 11 min Yes NA
15 D, 15-Dimensional; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; EQ-5D, European Quality of Life 5 Dimensions; FACT-G, functional
assessment of cancer therapy-general; HUI2, Health Utility Indices Mark 2; HUI3, Health Utility Indices Mark 3; IPAQ-7, International Physical Activity Questionnaire-7 day; MDASI, The MD Anderson Symptom
Inventory; NA, not applicable; NHP, Nottingham Health Profile; NR, not report; PedsQL, pediatric quality of life inventory; PROMIS-29, patient-reported outcomes measurement information system-29; SF- 12, 12-
Item short form health survey; SF-36, 36-item short form health survey; SF-6D, short form 6 dimensions; SOMS-7, screening for somatoform symptoms-7; WHOQOL-BREF, Wor ldHealth Organization Quality of
Life-BREF.
Xiong et al. International Journal of Surgery (2025)
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Table 2
Characteristics of the included DTC-related PROMs for DTC.
PROMs
Development
language Target population Names of (sub)Scales
Number of items Per
(sub)Scales
Completion
time Validation Comments
THYCA-QoL English Patients with thyroid
cancer
1. Neuromuscular
2. Voice
3. Concentration
4. Sympathetic
5. Throat/Mouth Problems
6. Psychological
7. Sensory
8. Scar
9. Chill
10. Tingling hands/feet
11. Gained weight
12. Headache
13. Interest of sex
1. 3 items
2. 2 items
3. 2 items
4. 2 items
5. 3 items
6. 4 items
7. 2 items
8. 1 item
9. 1 item
10. 1 item
11. 1 item
12. 1 item
13. 1 item
24 items in total
<5 min Yes NA
COH-TV English Patients with thyroid
cancer
1. Physical
2. Psychological
3. Social
4. Spiritual
1. 2 items
2. 13 items
3. 8 items
4. 7 items
30 items in total
About 10 min Yes NA
ThyPRO English Patients with thyroid
disease
1. Goiter symptoms
2. Hyperthyroid symptoms
3. Hypothyroid symptoms
4. Eye symptoms
5. Tiredness
6. Cognitive problems
7. Anxiety
8. Depression
9. Emotional susceptibility
10. Impaired social life
11. Impaired daily life 12.
Appearance
13. Overall QoL.
1. 11/3 items
2. 8/4 items
3. 4/4 items
4. 8/3 items
5. 7/3 items
6. 6/3 items
7. 6/3 items
8. 7/3 items
9. 9/3 items
10. 4/3 items
11. 6/3 items
12. 2/3 items
13. 6/1 items
84/39 items in total
About 14/
4 min
Yes Can be used to assess HRQOL
in patients with thyroid
disease.
EORTC-THY34 English Patients with thyroid
cancer
1. Discomfort in the head and neck
2. Fatigue
3. Fear
4. Hair problems
5. Restlessness
6. Social support
7. Swallowing
8. Worry about important others
9. Tingling or numbness
10. Voice concerns
11. Altered body image
12. Cramps
13. Dry mouth
14. Altered temperature tolerance
15. Impact on job or education
16. Joint pain
17. Shoulder function problems
1. 3 items
2. 3 items
3. 3 items
4. 2 items
5. 2 items
6. 3 items
7. 2 items
8. 4 items
9. 2 items
10. 3 items
11. 1 item
12. 1 item
13. 1 item
14. 1 item
15. 1 item
16. 1 item
17. 1 item
34 items in total
About 15 min Yes NA
UW-QOL English Patients with head
and neck cancer
Physiological functions
1. Chewing
2. Swallowing
3. Speech
4. Taste
5. Saliva
6. Appearance
Social functions
1. Anxiety
2. Mood
Physiological functions
1 item per subscale
Social functions
1 item per subscale
Global quality of life
3 items
15 items in total
About 5 min Yes Can be used to assess HRQOL
in patients undergoing
thyroidectomy and
radioiodine therapy.
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2. (Sub)Scale name and what PROMs were measured in the
literature. To further classify PROMs accurately, we consid-
ered (sub)scale name and what PROMs were measured in the
literature. For example, PROMs for measuring emotional
disorders in the general population were classified into
psychology-related PROMs; PROMs for measuring post-
operative symptoms in the TC population were classified into
operation-related PROMs.
Results
Based on the described search strategy, a total of 10 494 articles
were identified. Among them, 292 articles fulfilled all of the cri-
teria. Additional 38 eligible studies were identified by reference
check. An overview of the included articles can be found in
Appendix 1 (Supplemental Digital Content 4, http://links.lww.
com/JS9/D120). In total, these studies utilized 96 different
PROMs (Fig. 1).
Characteristics of the PROMs
The PROMs were developed in 12 different languages, most
often in English (N=94), followed by Finnish (N=2), Dutch
(N=2), and Hebrew (N=2). EQ-5D WHOQOL-BREF, and
ThyCa-HRQOL were developed in more than one language at
the same time. Of the 96 PROMs, there were 14 different PROMs
specifically developed for patients with TC. Tables 1–5 present a
summary of the (sub)scale name and items of the included
PROMs, as well as comments about them. For the 96 PROMs,
the reported completion time varied from 1 to 20 min. With
regard to validation of the PROMs, 88/96 PROMs were vali-
dated in different populations, while 8/96 PROMs (TQOLI,
TVQ, VIS, VII-5, SIS, UADS, CSQ, and FoR) have not yet been
validated.
Table 2
(Continued)
PROMs
Development
language Target population Names of (sub)Scales
Number of items Per
(sub)Scales
Completion
time Validation Comments
3. Pain
4. Activity
5. Recreation
6. Shoulder function
Global quality of life
MDASI-THY English Patients with thyroid
cancer
1. General cancer symptoms
2. Symptom-related interference
3. Thyroid-related symptoms
1. 13 items
2. 6 items
3. 6 items
25 items in total
NR Yes NA
EORTC-H&N35 English Patients with head
and neck cancer
1. Pain
2. Swallowing
3. Senses
4. Speech
5. Social eating
6. Social contact
7. Sexuality
8. Single items
1. 4 items
2. 4 items
3. 2 items
4. 3 items
5. 4 items
6. 5 items
7. 2 items
8. 11 items
35 items in total
About 8 min Yes NA
FACT-H&N English Patients with head
and neck cancer
1. Physical well-being
2. Social/family well-being
3. Emotional well-being
4. Functional well-being
5. Head and neck cancer specific
subscale
1. 7 items
2. 7 items
3. 6 items
4. 7 items
5. 11 items
38 items in total
7.3 ±2.7 min Yes NA
ThyCAT English Patients with thyroid
cancer
1. Physical
2. Psychologic
3. Social
4. Spiritual
75 items in total
<10 questions at a time
<2 min Yes Can Efficiently and accurately
identify HRQOL issues after
TC treatment.
ThyCa-HRQOL English
Filipino
Patients with thyroid
cancer
1. Perceived fears
2. Psychological distress/anxiety
3. Functionality
4. Voice complaints
5. Neck complaints
6. Cold intolerance
1. 6 items
2. 6 items
3. 5 items
4. 2 items
5. 2 items
6. 1 item
22 items in total
About 6 min Yes NA
TQOLI Hebrew Patients with thyroid
cancer
NA 15 items in total NR No NA
COH-TV, city of hope-thyroid version; EORTC QLQ THY34, EORTC quality of life module for thyroid cancer; EORTC-H& N35, European organization for research and treatment of cancer quality of life head and neck
module; FACT H&N, functional assessment of cancer therapy-head and neck scale; MDASI-THY, M.D Anderson Symptom Inventory-Thyroid Cancer Module; NA, not applicable; NR, not repor t; ThyCa-HRQOL,
thyroid cancer-specific health-related quality of life questionnaire; THYCA-QoL, thyroid cancer-specific quality of life; ThyCAT, thyroid compute rized adaptive tests; THYPRO, thyroid-specific patient reported
outcome; TQOLI, thyroid quality of life instrument; UW-QOL, University of Washington QOL.
Xiong et al. International Journal of Surgery (2025)
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Different categories of PROMs
According to the category criteria the PROMs were classified into
five categories (Figs 2–4), namely universal PROMs (16/96)
(Fig. 2A), DTC-related PROMs (Fig. 2B), radioiodine-related
PROMs (Fig. 2C), operation-related PROMs (Fig. 3), and psy-
chology-related PROMs (Fig. 4).
Of the 96 PROMs, there were 16 different universal
PROMs (Fig. 2A, Table 1). The most commonly used uni-
versal PROM was SF-36, followed by EORTC QLQ-C30, and
SF-12. Among the 16 unique PROMs, only PedsQL was
developed for assessing the quality of life in the pediatric
population. Eleven PROMs were grouped into DTC-related
PROMs (Fig. 2B, Table 2). THYCA-QOL was the most
commonly used, followed by COH-TV and ThyPRO. Of the
96 PROMs, there were four different radioiodine-related
PROMs (Fig. 2C, Table 3), of which XI (2/5) was the most
commonly utilized.
Of the 96 PROMs, 37 PROMs were classified as operation-
related PROMs (Fig. 3, Table 4). Depending on the symptoms
caused by surgery, the operation-related PROMs were sub-
divided into nine types of PROMs, namely voice (6/37), pain (2/
37), scar (5/37), swallow (8/37), fatigue (6/37), sleep (4/37), neck
and shoulder discomfort (4/37), cough (1/37), and sex (1/37)
(Fig. 3). Among them, VHI, VAS, PSAS, SIS, MFI-20,and PSQI
were the most commonly used PROMs. TVQ, VIS, VII-5, SIS,
UADS, and CSQ were specifically developed for thyr-
oidectomized patients.
Next, 28/96 PROMs were grouped into psychology-related
PROMs (Fig. 4, Table 5). Based on different emotional states,
the psychology-related PROMs were subdivided into four
types of PROMs, namely anxiety/depression/stress (21/28),
fear of surgery/disease progression/recurrence/survival (4/28),
self-esteem/discrimination (2/28), and attention (1/28). Among
them, HADS and FoP-Q were the most commonly used
PROMs. TCSPDS was specifically developed for TC patients.
Notably, only MASC was developed for assessing anxiety
levels in children.
Discussion
This systematic review provided an overview of the available
PROMs applied in patients with DTC with a focus on compre-
hensively reviewing PROMs, innovatively categorizing PROMs,
and describing the frequency with which PROMs were used in
previous studies.
In many studies, authors have generally compared the
HRQOL of the general population or patients with benign
thyroid disease with that of the TC population by SF-36
[19–36]
.In
addition, some researchers have argued that cancer-specific
PROMs are not optimal to assess long-term HRQOL in TC
patients many years after treatment; instead, SF-36 may be better
for assessment of the patients’long-term HRQOL
[37]
. However,
EORTC-C30 has been also used in many studies to measure
HRQOL in TC patients
[30,38–44]
due to the fact that EORTC-C30
can not only evaluate cancer-specific HRQOL, but can also
capture some issues associated with TC, such as fatigue and
insomnia. Moreover, the validity and reliability of EORTC-C30
have been validated in adult Filipinos with DTC
[45]
. Although
EQ-5D has been the most commonly used preference-based
generic utility instrument, due to the higher floor effect, SF-6D
was more sensitive to treatment effects of DTC than EQ-5D
[46,47]
.
It is worth noting that the PROMIS-29 metric is T-score, which
makes it possible and more convenient for researchers to compare
the HRQOL in the general population or other cancer patients
with that of DTC patients
[48,49]
.
As for DTC-related PROMs, Uslar et al.
[8]
systematically
reviewed nine malignant thyroid disease PROMs and described
the content, reliability, and validity of only six PROMs (three
questionnaires were only mentioned). Unlike the review by Uslar
et al., our present review did not include two unnamed DTC-
related PROMs, and we categorized ThyPRO into DTC-related
PROMs. The systematic review by Roth et al.
[7]
identified 15
PROMs applied in the TC population, summarized psychometric
properties, and described the results of the included HRQOL
studies. Compared with three categories used by Roth et al., our
study reviewed more PROMs used in the TC population and
Table 3
Characteristics of the included radioiodine-related PROMs for DTC.
PROMs
Development
language Target population Names of (sub)Scales
Number of items per
(sub)Scales
Completion
time Validation Comments
XI English Individuals with
xerostomia
NA 11 items in total About 1 min Yes NA
XQ English Individuals with
xerostomia
NA 8 items in total NR Yes NA
FAACT English Cancer patients 1. Physical well-being
2. Social/family well-being
3. Emotional well-being
4. Functional well-being
5. Anorexia cachexia subscale
1. 7 items
2. 7 items
3. 6 items
4. 7 items
5. 12 items
39 items in total
NR Yes Can be used to measure general
aspects of quality of life as well as
specific anorexia/cachexia-related
concerns.
XeQOLS English Patients with head and
neck cancer
1. Physical functioning
2. Pain/discomfort issues
3. Personal/psychological
functioning
4. Social functioning
1. 4 items
2. 4 items
3. 4 items
4. 3 items
15 items in total
About
4.5 min
Yes NA
FAACT, functional assessment of anorexia and cachexia treatment; NA, not applicable; NR, not report; XeQOLS, xerostomia-related quality of life scale; XI, xerostomia inventory; XQ, xerostomy questionnaire.
Xiong et al. International Journal of Surgery (2025) International Journal of Surgery
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Table 4
Characteristics of the included operation-related PROMs for DTC.
PROMs
Development
language Target population
Names of (sub)
scales
Number of items per (sub)
scales
Completion
time Validation Comments
Voice
VHI-30/10 English Patients with voice
disorders
1. Functional
2. Emotional
3. Physical
10 items per scale
30 items in total/
1. 5 items
2. 2 items
3. 3 items
10 items in total
5–10/
<5 min
Yes NA
TVQ English Thyroidectomized Patients
with voice disorders
1. Voice change
2. Throat discomfort
10 items per scale
20 items in total
NR No Can be used to evaluate pre-
and post-operative vocal
status as well as throat
and neck discomfort.
V-RQOL English Dysphonic patients 1. Social-Emotional
2. Physical
functioning
1. 4 items
2. 6 items
10 items in total
<5 min Yes NA
VIS English Thyroidectomized Patients
with voice disorders
NA 10 items in total NR No NA
VII-5 English Thyroidectomized Patients
with voice disorders
NA 5 items in total NR No Can be used to evaluate
specific voice impairments
because of injuries of the
external branch of the
superior laryngeal nerve
VoiSS English Patients with voice
disorders
1. Impairment
2. Emotional
3. Related physical
symptoms
1. 15 items
2. 8 items
3. 7 items
30 items in total
<10 min Yes NA
Pain
VAS English Patients with pain NA 1 items in total <1 min Yes NA
NRS English Patients with pain NA 1 items in total <1 min Yes NA
Scar
PSAS Dutch Patients with different types
of wounds.
NA 6 items in total 2-5 min Yes NA
PSAQ English Patients with scars. 1. Scar Appearance
2. Symptoms
3. Consciousness
4. Satisfaction with
Scar Appearance
5. Satisfaction with
Scar Symptoms
1. 10 items
2. 7 items
3. 7 items
4. 9 items
5. 6 items
39 items in total
About
7.3 min
Yes Subscales can be used
independently of each other
to allow assessment of
scar change in specific
domains
CSQ English Thyroidectomized patients 1. Cosmetic
satisfaction
2. Scar consciousness
3. Two questions
about the axilla and
breast scar
1. 2 items
2. 4 items
3. 2 items
8 items in total
NR No Can be used to measure
subjective cosmetic
satisfaction and scar
consciousness in the
conventional or robotic or
endoscopic thyroidectomy
group
DLQI English Patients with different skin
diseases.
NA 10 items in total 1–3 min Yes NA
BIS English Cancer patients NA 10 items in total NR Yes NA
Swallow
SIS English Thyroidectomized patients
with dysphagia
NA 6 items in total NR No NA
MDADI English Head and neck cancer
patients with dysphagia
1. Global
2. Emotional
3. Functional
4. Physical
1. 1 item
2. 7 items
3. 4 items
4. 8 items
20 items in total
<5 min Yes NA
DHI English Patients with dysphagia 1. Emotional
2. Functional
3. Physical
1. 7 items
2. 9 items
3. 9 items
25 items in total
NR Yes NA
Xiong et al. International Journal of Surgery (2025)
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Table 4
(Continued)
PROMs
Development
language Target population
Names of (sub)
scales
Number of items per (sub)
scales
Completion
time Validation Comments
SWAL-QOL English Patients with oropharyngeal
dysphagia
1. Burden of eating
difficulty
2. Eating duration
3. Eating desire
4. Symptom
frequency
5. Food selection
6. Communication
7. Fear
8. Mental health
9. Social impact
10. Fatigue
11. Sleep
1. 2 items
2. 2 items
3. 3 items
4. 14 items
5. 2 items
6. 2 items
7. 4 items
8. 5 items
9. 5 items
10. 3 items
11. 2 items
44 items in total
About 10 min Yes NA
UADS English Thyroidectomized patients
with upper aerodigestive
symptoms
1. Vocal symptoms
2. Swallowing
symptoms
1. 6 items
2. 10 items
16 items in total
NR No Can be used to assess
thyroidectomized patient’s
upper aerodigestive
symptoms.
EAT-10 English Patients with dysphagia NA 10 items in total <2 min Yes NA
GETS English Patients with throat
symptoms
NA 10 items in total <5 min Yes NA
RSI English Patients with reflux
symptoms or nonvoice
throat symptoms
NA 9 items in total <2 min Yes Nonvoice throat symptoms
include cough, choking, or
throat clearing, which are
present after thyroidectomy
Fatigue
MFI-20 English Patients with fatigue 1. General fatigue
2. Physical fatigue
3. Reduction in activity
4. Reduction in
motivation
5. Mental fatigue
4 items per subscale
20 items in total
About 4 min Yes NA
BFI English Cancer patients with fatigue NA 9 items in total <3 min Yes NA
FACIT-F English Patients with fatigue NA 13 items in total <3 min Yes NA
CFS English Cancer patients with fatigue 1. Physical
2. Cognitive
3. Affective
1. 7 items
2. 4 items
3. 4 items
15 items in total
About 2 min Yes NA
CFQ English Population with fatigue 1. Physical fatigue
2. Mental fatigue
1. 7 items
2. 4 items
11 items in total
3–5 min Yes NA
FAS English Population with fatigue 1. Physical fatigue
2. Mental fatigue
1. 5 items
2. 5 items
10 items in total
NR Yes NA
Sleep
PSQI English Patients with sleep
disorders
1. Subjective sleep
quality
2. Sleep latency
3. Sleep duration
4. Habitual sleep
efficiency
5. Sleep disturbances
6. Use of sleeping
medication
7. Daytime
dysfunction (seven
component scores)
1. 1 item
2. 2 items
3. 1 item
4. 2 items
5. 9 items
6. 1 item
7. 2 items
19 self-rated items and 5
bedpartner or roommate
rated items in total
5–10 min Yes NA
ISI English Insomnia patients NA 7 items in total <5 min Yes NA
SSS English General patients or Patients
with sleep disorders.
NA 1 seven-point item <1 min Yes NA
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categorized them into five types. In the review by Wong et al.
[9]
,a
COSMIN checklist was used to grade the methodological quality
and overall evidence levels of 14 included thyroid-specific
PROMs. Given that most of what Wong et al. graded were benign
thyroid disease PROMs, further research was needed to measure
the methodological quality of TC-specific PROMs using a
COSMIN checklist and to provide a recommendation.
With regard to radioiodine-related PROMs, most PROMs
used in previous studies evaluated the effect of radioiodine-
induced xerostomia on TC patients’HRQOL
[13,14,50]
, and only
one questionnaire utilized in a study assessed the impact of
radioiodine-induced anorexia on HRQOL
[51]
. Thus far, few
studies have applied specific PROMs to assess TC patients’
HRQOL after radioiodine therapy, and there has been a lack of
PROMs developed specifically for the TC population after
radioiodine therapy, therefore, more studies are needed.
Most of the studies that measured TC patients’HRQOL after
thyroidectomy measured the impact of voice changes on HRQOL
using VHI-10/30
[10,52–60]
. Notably, although TVQ, VIS and VII-
5 were developed for thyroidectomized patients to evaluate voice
impairments, none of them were validated and none underwent
phase IV testing. In most studies
[61–69]
, VAS was often used for
postoperative pain assessment after open thyroidectomy versus
endoscopic thyroidectomy (transoral, axillary, axillo-breast,
areola, and retroauricular) versus robotic thyroidectomy. With
regard to postoperative scarring, it is worth mentioning that both
PSAS and PSAQ have been validated in thyroidectomized
patients
[70,71]
, and the reason why PSAS was more often used
may be due to its fewer items
[72–83]
. Swallowing discomfort often
exists in TC patients after surgery, which has generally assessed
by SIS developed for thyroidectomized patients; however, it has
not been validated
[16,52,84–93]
. Both MFI-20 and BFI are com-
monly used to evaluate post-treatment fatigue in TC patients, but
no fatigue PROM has been developed specifically for TC patients.
There were eight studies measuring the sleep quality of TC
patients after surgery, most of which used PSQI and only one
utilized ISI
[94–101]
. Hitherto, there has been no review of sleep
quality in TC, so further research should be conducted based on
Table 4
(Continued)
PROMs
Development
language Target population
Names of (sub)
scales
Number of items per (sub)
scales
Completion
time Validation Comments
ESS English General patients or Patients
with sleep disorders.
NA 8 items in total <5 min Yes Measuring the subject’s
general level of daytime
sleepiness by rating the
chances that the subject
would doze off or fall asleep
in different situations
Neck and shoulder discomfort
NOOS English Patients with neck pain 1. Mobility
2. Symptoms
3. Sleep disturbance
4. Every day activity
and pain
5. Participation in
everyday life
1. 7 items
2. 5 items
3. 4 items
4. 8 items
5. 10 items
34 items in total
About 10 min Yes NA
NPDS English Patients with neck pain NA 20 items in total 15–20 min Yes NA
DASH English Patients with a variety of
upper limb disorders.
1. Physical function
2. Symptom
3. Social or role
function
1. 21 items
2. 6 items
3. 3 items
30 items in total
About 4 min Yes NA
NDII English Patients following neck
dissection
NA 10 items in total NR Yes NA
Cough
LCQ English Patients with chronic cough 1. Physical
2. Psychological
3. Social
1. 8 items
2. 7 items
3. 4 items
19 items in total
About 5 min Yes NA
Sex
RAS English General population or
patients
NA 7 items in total NR Yes Measuring general
relationship quality in
individuals involved in an
intimate relationship
BFI, brief fatigue inventory; BIS, body image scale; CFQ, Chalder fatigue questionnaire; CFS, cancer fatigue scale; CSQ, cosmetic satisfaction questionnaire; DASH, disabilities of the arm, shoulder and hand; DHI,
dysphagia handicap index; DLQI, dermatology life quality index; EAT-10, eating assessment tool-10; ESS, Epworth Sleepiness Scale; FACIT-F, functional assessment of chronic illness therapy fatigue; FAS, fatigue
assessment scale; GETS, Glasgow Edinburgh Throat Scale; ISI, insomnia severity index; LCQ, Leicester Cough Questionnaire; MDADI, M. D. Anderson Dysphagia Inventory; MFI-20, multidimensional fatigue
index‐20; NA, not applicable; NDII, neck dissection impairment index; NOOS, neck outcome scale; NPDS, neck pain and disability scale; NR, not report; NRS, numeric rating scale; PSAQ, patient scar asses sment
questionnaire; PSAS, patient scar assessment scale; PSQI, Pittsburgh sleep quality index; RAS, relationship assessment scale; RSI, reflux symptom index; SIS, swallowing impairment score; SSS, Stanford
sleepiness scale; SWAL-QOL, swallowing quality of life; TVQ, thyroidectomy-related voice questionnaire; UADS, upper aerodigestive symptoms questionnaire; VAS, visual analog scale; VHI-30/10, voice handicap
index-30/10; VII-5, voice impairment index-5; VIS, voice impairment score; VoiSS, voice symptom scale; V-RQOL, voice-related quality of life.
Xiong et al. International Journal of Surgery (2025)
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Table 5
Characteristics of the included psychology-related PROMs for DTC.
PROMs
Development
language Target population Names of (sub)Scales
Number of items
per (sub)Scales
Completion
time Validation Comments
Anxiety/Depression/Stress
HADS English Population with emotional
disorders
1. Anxiety
2. Depression
1. 7 items
2. 7 items
14 items in total
2–5 min Yes NA
BDI English Depressed Population NA 21 items in total About 5 min Yes NA
STAI English Population with anxiety 1. A-State
2. A-Trait
1. 20 items
2. 20 items
40 items in total
15–20 min Yes Differentiating between the
temporary condition of
state-anxiety and the more
general and longitudinal
quality of trait-anxiety
BAI English Population with anxiety NA 21 items in total About 5 min Yes NA
SDS English Population with depressive
disorder
NA 20 items in total About 15 min Yes NA
SAS English Population with anxiety NA 20 items in total About 15 min Yes NA
DT English Patients with distress NA 1 item in total <1 min Yes Measuring patients’general
level of distress via a 10-
points scale ranging from 0
to 10
POMS English Population with mood disturbance 1. Tension-Anxiety
2. Depression-Dejection
3. Anger-Hostility
4. Vigor-Activity
5. Fatigue-Inertia
6. Confusion-Bewilderment
7. Friendliness
1. 9 items
2. 15 items
3. 12 items
4. 8 items
5. 7 items
6. 7 items
7. 7 items
65 items in total
NR Yes NA
PHQ-9 English Depressed population NA 9 items in total About 2 min Yes NA
GAD-7 English Population with anxiety NA 7 items in total <2 min Yes NA
DASS-21 English Population with emotional
disorders
1. Depression
2. Anxiety
3. Stress
7 items per subscale
21 items in total
5–10 min Yes Measuring three related
negative affective states of
depression, anxiety, and
stress.
KSQ English Population with psychological
distress
1. Depression
2. Anxiety
3. Anger-hostility
4. Somatic symptoms
23 items per scale
92 items in total
NR Yes NA
PGWBI English General population or patients with
stress-related exhaustion
1. Anxiety
2. Depression
3. Positive mood
4. Vitality
5. Self-control
6. General health
1. 5 items
2. 3 items
3. 4 items
4. 4 items
5. 3 items
6. 3 items
22 items in total
<10 min Yes NA
CES-D English General population or depressed
population
NA 20 items in total 2–5 min Yes NA
SHAI-14 English Patients with anxiety NA 14 items in total NA Yes NA
ASI English Patients with anxiety 1. Physical
2. Cognitive
3. Social
1. 8 items
2. 4 items
3. 4 items
16 items in total
<5 min Yes NA
MASC English Children or adolescents with
anxiety
1. Physical symptoms
2. Social anxiety
3. Harm avoidance
4. Separation anxiety
1. 12 items
2. 9 items
3. 9 items
4. 9 items
39 items in total
About 15 min Yes Assessing anxiety levels in
children.
GHQ-12 English Population with mental disorders NA 12 items in total <5 min Yes NA
ET English Patients with emotional disorders 1. Distress
2. Anxiety
3. Depression
4. Anger
5. Need for help
1 item per subscale
5 items in total
1–2 min Yes NA
Xiong et al. International Journal of Surgery (2025) International Journal of Surgery
1322

this review. To date, only four studies have investigated the
impact of postoperative shoulder and neck discomfort on the
HRQOL of TC patients by four different PROMs
[11,87,102,103]
,
and no PROMs have been developed specifically for TC patients.
Therefore, more research is needed. Wu et al.
[104]
firstly and
innovatively reported the association between postoperative
cough and thyroidectomy by LCQ. Currently, there are only two
studies specifically evaluating the effect of postoperative cough on
TC patients’HRQOL
[104,105]
; hence, further research is needed
on this aspect. Only one study measured patient-partner rela-
tionship quality in TC patients
[106]
, and more research is needed
to support that study. Following thyroid surgery, hypocalcemia
has frequently been observed
[107]
, which can lead to numbness in
the hands or feet. Nevertheless, no PROMs have been developed
specifically for TC patients with hypocalcemia up to this point.
More research is required to develop specific PROMs.
Many of the included studies have focused on the psycholo-
gical status after TC treatment, such as anxiety, depression, and
stress, which were often measured by HADS, BDI, and
STAI
[32,108–115]
. When we determined the PROMs, we did not
include HAMA and HAMD because none of them are self-rated
scales. In some of the included studies, authors measured the
psychological status of fear of disease progression in TC patients
by FoP-Q
[109,116–121]
.
This study reveals a large number of PROMs for measuring the
HRQOL of DTC patients. We described the frequency with
which PROMs were utilized for measuring the HRQOL of DTC
patients in previous studies. In this way, not only can we directly
understand which PROM is the most commonly used, but we
could also indirectly know which aspects of HRQOL have been
studied more extensively. The 96 PROMs were innovatively
classified into five categories, namely universal PROMs, DTC-
Table 5
(Continued)
PROMs
Development
language Target population Names of (sub)Scales
Number of items
per (sub)Scales
Completion
time Validation Comments
PANAS English Population with mood disorders 1. Positive affect
2. Negative affect
1. 10 items
2. 10 items
20 items in total
About 10 min Yes NA
TIWI English General population NA 3 items in total About 1 min Yes Assessing general worry.
Fear of surgery/disease progression/recurrence/survive
FoP-Q English Chronically ill patients 1. Affective reactions
2. Partnership/family
3. Work
4. Loss of autonomy
5. Coping with anxiety
1. 13 items
2. 7 items
3. 7 items
4. 7 items
5. 9 items
43 items in total
<20 min Yes Evaluating anxiety and fear of
disease progression.
ASC English Cancer patients 1. Cancer worry
2. Health worry
1. 3 items
2. 2 items
5 items in total
NR Yes NA
SFQ English Surgery patients 1. Fear of the short-term
consequences of surgery
2. Fear of the long-term
consequences of surgery
4 items per subscale
8 items in total
NR Yes NA
FoR English Cancer patients NA 7 items in total NR No NA
Self-esteem/
Discrimination
PSI English Healthy or ill population 1. Global self-esteem
2. Physical self-worth
3. Sport competence
4. Physical condition
5. Attractive body
6. Physical strength
1 item per subscale
6 items in total
NR Yes NA
TCSPDS English Patients with thyroid cancer 1. Stigma
2. Self-deprecation
3. Social avoidance
1. 8 items
2. 6 items
3. 6 items
20 items in total
About 15 min Yes Can be used to assess self-
perceived discrimination in
TC patients.
Attention
AFI English Healthy or ill population 1. Effective action
2. Attentional lapses
3. Interpersonal effectiveness
1. 7 items
2. 3 items
3. 3 items
13 items in total
NR Yes Assessing individuals’
perceived effectiveness.
AFI, attentional function index; ASC, assessment of survivor concerns; ASI, anxiety sensitivity index; BAI, beck anxiety inventory; BDI, beck depression invent ory; CES-D, center for epidemiologic studies depression
scale; DASS-21, depression anxiety stress scales-21; DT, distress thermometer; ET, emotion thermometers; FoP-Q, fear of progression questionnaire; FoR, fear of recurrence; GAD-7, generalized anxiety
disorder-7; GHQ-12, general health questionnaire-12; HADS, hospital anxiety and depression scale; KSQ, Kellner symptoms questionnaire; MASC, multidimensional anxiety scale for children; NA, not applicable;
NR, not report; PANAS, positive and negative affect schedule; PGWBI, psychological general well-being index; PHQ-9, patient health questionnaire-9; POMS, profile of mood states; PSI, physical self-inventory;
SAS, self-rating anxiety scale; SDS, self-rating depression scale; SFQ, surgical fear questionnaire; SHAI-14, short health anxiety inventory-14; STAI, state-trait anxiety inventory; TCSPDS, thyroid cancer self-
perceived discrimination scale; TIWI, three-item worry index.
Xiong et al. International Journal of Surgery (2025)
1323

related PROMs, radioiodine-related PROMs, operation-related
PROMs, and psychology-related PROMs. Combining the rele-
vant information and frequency of PROMs utilization, it can
provide convenience and reference for researchers to select
PROMs across different categories.
This systematic review has several limitations. First, we only
described the (sub)scale names of PROMs, which is not enough
for researchers to accurately select PROMs, so it would be better
for researchers to view the content of the PROMs to determine
which aspects of HRQOL have been assessed. Second, selecting a
reliable PROM also requires evaluating measurement properties
with a COSMIN checklist and giving recommendations, similar
to the study by Wong et al.
[9]
. However, due to the large number
of PROMs involved in this review, measurement properties were
not evaluated, and further research is needed. Third, the criteria
for each category were subjective. Finally, despite the extensive
search, we determined 12% of the included studies from reference
lists. However, based on this extensive search strategy, our sys-
tematic review identified 96 PROMs, which is far more than
those included in previous reviews
[7,8]
.
Figure 2. Frequency with which universal PROMs (2A), DTC-related PROMs (2B), and radioiodine-related PROMs (2C) were utilized in the included studies.
SF-36, 36-item short form health survey; EORTC QLQ-C30, European Organization for research and treatment of cancer quality of life questionnaire core
30; SF-12, 12-item short form health survey; EQ-5D, European Quality of Life 5 Dimensions; PROMIS-29, patient-reported outcomes measurement
information system-29; WHOQOL-BREF, World Health Organization Quality of Life-BREF; FACT-G: Functional Assessment of Cancer Therapy-General; SF-
6D, Short Form 6 Dimensions; PedsQL, pediatric quality of life inventory; SOMS-7, screening for somatoform symptoms-7; IPAQ-7, international physical
activity questionnaire-7 day; MDASI, The MD Anderson Symptom Inventory; HUI2, Health Utility Indices Mark 2; HUI3, Health Utility Indices Mark 3;15 D:
15-Dimensional, NHP, Nottingham Health Profile; THYCA-QoL, Thyroid Cancer-Specific Quality of Life; COH-TV, City of Hope-Thyroid Version; THYPRO,
Thyroid-Specific Patient Reported Outcome; EORTC QLQ THY34, EORTC Quality of Life Module for Thyroid Cancer; UW-QOL, University of Washington
QOL; MDASI-THY, M.D Anderson Symptom Inventory-Thyroid Cancer Module; EORTC-H&N35, European Organization for Research and Treatment of
Cancer quality of life Head and Neck module; FACT H&N, Functional Assessment of Cancer Therapy-Head and Neck Scale; ThyCAT, Thyroid
Computerized Adaptive Tests; ThyCa-HRQOL, Thyroid Cancer-Specific Health-Related Quality of Life Questionnaire; TQOLI, Thyroid Quality of Life
Instrument; XI, Xerostomia Inventory; XQ, Xerostomy Questionnaire; FAACT, Functional Assessment of Anorexia and Cachexia Treatment; XeQOLS,
Xerostomia-Related Quality of Life Scale.
Xiong et al. International Journal of Surgery (2025) International Journal of Surgery
1324

Figure 3. Frequency with which operation-related PROMs were utilized in the included studies. VHI-30/10, Voice Handicap Index-30/10; TVQ, Thyroidectomy-
Related Voice Questionnaire; V-RQOL, Voice-Related Quality of Life; VIS, Voice Impairment Score; VII-5, Voice Impairment Index-5; VoiSS, Voice Symptom Scale;
VAS, visual analog scale; NRS, numeric rating scale; PSAS, patient scar assessment scale; PSAQ, patient scar assessment questionnaire; CSQ, cosmetic
satisfaction questionnaire; DLQI, dermatology life quality index; BIS, body image scale; SIS, swallowing impairment score; MDADI, M. D. Anderson Dysphagia
Inventory; DHI, Dysphagia Handicap Index; SWAL-QOL, Swallowing Quality Of Life; UADS, Upper Aerodigestive Symptoms Questionnaire; EAT-10, Eating
Assessment Tool-10; GETS, Glasgow Edinburgh Throat Scale; RSI, Reflux Symptom Index; MFI-20, Multidimensional Fatigue Index‐20; BFI, Brief Fatigue
Inventory; FACIT-F, Functional Assessment of Chronic Illness TherapyFatigue; CFS, Cancer Fatigue Scale; CFQ, Chalder Fatigue Questionnaire; FAS, Fatigue
Assessment Scale; PSQI, Pittsburgh sleep quality index; ISI, Insomnia Severity Index; SSS, Stanford Sleepiness Scale; ESS, Epworth Sleepiness Scale; NOOS,
Neck Outcome Scale; NPDS, Neck Pain and Disability Scale; DASH, Disabilities of the Arm, Shoulder and Hand; NDII, Neck Dissection Impairment Index; LCQ,
Leicester Cough Questionnaire; RAS, Relationship Assessment Scale.
Xiong et al. International Journal of Surgery (2025)
1325

Conclusion
A large number of PROMs to evaluate all aspects of HRQOL are
available for patients with DTC. Combining the relevant infor-
mation and frequency of PROMs utilization, it can provide
convenience and reference for researchers to select PROMs across
different categories. However, a more detailed critical appraisal
of the PROMs used in various clinical scenarios is required.
Additionally, PROMs usage frequency in previous studies can
indirectly indicate the comprehensiveness or gaps in HRQOL
aspects studied, guiding further review or research.
Ethical approval
Not applicable.
Consent
Not applicable.
Source of funding
This work was supported by the grant 2022-YF05-01847-SN
from the Chengdu Science and Technology Bureau technology
innovation research and development project. The funder had no
role in the design and conduct of the study, collection, manage-
ment, analysis, interpretation of the data, preparation, review,
approval of the manuscript, and decision to submit the manu-
script for publication.
Author contribution
L.X.: writing –original draft, investigation, methodology, vali-
dation, and visualization; L.L. and Y.X.: investigation, metho-
dology, and validation; C.L.: methodology, writing –review and
editing, and supervision; W.D.: methodology, writing –review
and editing, and supervision; J.H., C.S., Y.Z., and X.W.: inves-
tigation; Y.C.: conceptualization, funding acquisition, methodol-
ogy, writing –review and editing, supervision, and visualization.
Figure 4. Frequency with which psychology-related PROMs were utilized in the included studies. HADS, hospital anxiety and depression scale; BDI, beck
depression inventory; STAI, state-trait anxiety inventory; BAI, beck anxiety inventory; SDS, self-rating depression scale; SAS, self-rating anxiety scale; DT, distress
thermometer; PHQ-9, patient health questionnaire-9; POMS, profile of mood states; GAD-7, generalized anxiety disorder-7; KSQ, Kellner symptoms ques-
tionnaire; DASS-21, depression anxiety stress scales-21; PGWBI, psychological general well-being index; CES-D, center for epidemiologic studies depression
scale; SHAI-14, short health anxiety inventory-14; ASI, anxiety sensitivity index; MASC, multidimensional anxiety scale for children; GHQ-12, general health
questionnaire-12; ET, emotion thermometers; PANAS, positive and negative affect schedule; TIWI, three-item worry index; FoP-Q, fear of progression ques-
tionnaire; ASC, assessment of survivor concerns; SFQ, surgical fear questionnaire; FoR, fear of recurrence; PSI, physical self-inventory; TCSPDS, thyroid cancer
self-perceived discrimination scale; AFI, attentional function index.
Xiong et al. International Journal of Surgery (2025) International Journal of Surgery
1326

Conflicts of interest disclosure
No conflict of interest exits in the submission of this manuscript,
and the manuscript is approved by all authors for publication.
Research registration unique identifying number
(UIN)
1. Name of the registry: PROSPERO database.
2. Unique identifying number or registration ID:
CRD42024549483.
3. Hyperlink to your specific registration (must be publicly
accessible and will be checked): https://www.crd.york.ac.uk/
prospero/display_record.php?RecordID=549483
Guarantor
Yongcong Cai.
Data availability statement
The authors confirm that the data supporting the findings of this
study are available within the supplementary materials.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Acknowledgement
The authors thank LetPub (www.letpub.com) for its linguistic
assistance during the preparation of this manuscript.
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