Follow-up Programs in Thyroid Cancer

Abstract

Any follow-up program after thyroid cancer will have to start with the decision about what to tell the patient and his family concerning the nature, spread and prognosis of the disease. If patients are discharged believing that they had only simple goiter, they frequently tend to neglect prescribed medication and adequate follow-up appointments. If on the other hand a patient — e.g. at an age of 55 years with metastatic poorly differentiated follicular carcinoma and with lesions in lungs and bone — is informed precisely about the chances for a long-term cure even with all the available therapeutic facilities some will have a nervous break-down (going as far a suicide!) or refuse any further treatment, because he or she may feel that all is lost. Several such patients then seek advice from obscure “cancer centers”, see the local “Njanja” (=witch doctor) in developing countries, thus losing any chance for a cure or at least middle-term stabilization of their ailment. Between these 2 extremes there is a large variety of individual situations depending on the intellectual capacity of the patients, cooperation from his family and local physicians, pathology, tumor stage and the willingness of the afflicted person to fight for life. Under such circumstances it is impossible of course to “prescribe” general guidelines for adequate patient information, which — on the other hand — is a significant factor for the implementation of appropriate follow-up programs. It takes a lot of psychological knowledge and experience as well as a close relationship with the patient to be able — at least in most cases — to inform the patient in the right way, to convince his family of the necessity and benefits of a long-term follow-up and to establish a proper, sincere and active relationship between patient and treating doctor. This fact has been known for more than 2000 years (Ebers 1875), has sometimes been forgotten in the last century but is increasingly accepted again today (Illich 1976). Ultimately therefore the final success of therapy for thyroid cancer will depend not only on the ability and technical finesse of the treating doctors but also on the active cooperation of the patients.