Examining the Sequential Relationships Between Voice Changes, Symptom Experiences, Fear of Cancer Recurrence, and Voice-Related Quality of Life in Patients With Thyroid Cancer: A Cross-sectional Study.

[BACKGROUND] Thyroid cancer is considered lower-grade cancer with a high survival rate; however, the voice changes, and the presence of other diverse symptoms following a thyroidectomy can impact a patient's voice-related quality of life (VRQOL).

[OBJECTIVE] This study aimed to examine the serial multiple mediating effects of voice changes, symptom experiences, and fear of cancer recurrence on the VRQOL among patients diagnosed with thyroid cancer postthyroidectomy.

[METHODS] This cross-sectional study used a descriptive, structured self-report questionnaire. A total of 225 individuals participated who were 20 years and older, had been diagnosed with thyroid cancer and had undergone thyroidectomy surgery at comprehensive university hospitals in Daegu, Daejeon, Sejong, and Anyang in South Korea before data collection.

[RESULTS] The study's findings revealed a statistically significant direct impact between patients' voice changes and their VRQOL. Moreover, the serial mediation model highlighted that as the severity of patients' voice changes escalated, the intensity of their other symptom experiences and fear of cancer recurrence increased, resulting in a deterioration in their VRQOL. The study's findings identified partial mediating effects of symptom experiences and the fear of cancer recurrence in the association between voice changes and the VRQOL.

[CONCLUSIONS] These findings underscore the importance of adopting a modeling approach that considers the simultaneous sequential relationships among 4 pivotal variables, namely, voice changes, symptom experiences, fear of cancer recurrence, and VRQOL.

[IMPLICATIONS FOR PRACTICE] The findings highlight the crucial impact of voice changes on patients' VRQOL, which is closely linked to various psychological aspects of the disease.