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The Thyroid Cancer Modified Anxiety Scale (TC-MAX): Development and External Validation of a Thyroid Cancer Distress
Amanda J Bastien1, Sungjin Kim2,3, Cynthia Zalt2
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Thyroid : Official Journal of the American Thyroid Association
|August 11, 2026
Summary
The Thyroid Cancer Modified Anxiety Scale (TC-MAX) is a new tool to measure patient anxiety related to thyroid cancer. It shows strong reliability and validity, helping guide treatment decisions.
Area of Science:
- Psychometrics
- Oncology
- Endocrinology
Background:
- Patient distress significantly impacts thyroid cancer treatment choices but is often underestimated by clinicians.
- A validated tool is needed to accurately measure patient-reported anxiety specific to thyroid cancer.
Purpose of the Study:
- To develop and validate the Thyroid Cancer Modified Anxiety Scale (TC-MAX).
- To assess patient-reported worry associated with thyroid cancer and its treatment.
Main Methods:
- Conceptualization involved literature review, expert panels, and patient focus groups.
- Development included qualitative revision, pilot testing, and internal validation (n=148).
- External validation (n=1002) assessed psychometric properties including reliability and construct validity.
Main Results:
- The 18-question TC-MAX scale comprises three subscales: Collective Anxiety, Ultrasound Anxiety, and Fear of Recurrence/Progression.
- High internal consistency (Cronbach's α = 0.93) and test-retest reliability (ICC = 0.86) were observed during internal validation.
- External validation confirmed robust psychometric properties, with similar internal consistency (α = 0.94) and reliability (ICC = 0.87).
Conclusions:
- TC-MAX is the first dedicated measure of anxiety in thyroid cancer patients, demonstrating strong psychometric properties.
- The scale effectively captures patient perspectives and can inform treatment decisions, including suitability for active surveillance or extent of surgery.