Factors Associated with Sleep Disruption and Fatigue in Thyroid Cancer Survivors

Thyroid cancer survivors often experience worse quality of life than other cancer survivors, with fatigue and sleep disturbance being common contributors. In this prospective cohort from the ICaRe2 cancer registry, survivors completed the Brief Fatigue Inventory (BFI) and Pittsburgh Sleep Quality Index (PSQI) at enrollment and follow-up, with univariate and multivariable analyses identifying factors associated with fatigue and sleep quality. Among 249 survivors (83% female, median age 42), 205 completed the BFI and 224 the PSQI. Most were low (57%) or intermediate (34%) risk or recurrence at diagnosis, and 74% had no structural recurrence. Poor sleep and greater fatigue were significantly associated with female sex (p = 0.0003 and 0.001), younger age at diagnosis (p = 0.02 and 0.0006), and vocal cord paralysis (p = 0.01 and 0.046). Fatigue was also higher in those with hypoparathyroidism (p = 0.04). No associations were found with recurrence risk, therapy response, thyroid hormone type, or TSH levels. Younger female survivors, particularly those with vocal cord paralysis or hypoparathyroidism, are more prone to fatigue and poor sleep, highlighting potential targets for interventions to improve quality of life.