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Thyroid. 2017 Sep;27(9):1156-1163. doi: 10.1089/thy.2016.0541. Epub 2017 Aug 14.

An Exploratory Study of Fatigue and Physical Activity in Canadian Thyroid Cancer Patients.

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1 Division of Endocrinology, Department of Medicine, University of Toronto , Toronto, Canada .
2 Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre , Toronto, Canada .
3 Department of Psychiatry, University of Toronto , Toronto, Canada .
4 Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto , Toronto, Canada .
5 Faculty of Kinesiology and Physical Education, University of Toronto , Toronto, Canada .
6 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Canada .
7 Department of Physical Medicine and Rehabilitation, Department of Medicine, Toronto Rehabilitation Institute and University of Toronto , Toronto, Canada .
8 Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto , Toronto, Canada .
9 Division of Endocrinology, Department of Medicine, University Health Network Toronto , Toronto, Canada .



Fatigue is common among cancer survivors, but fatigue in thyroid cancer (TC) survivors may be under-appreciated. This study investigated the severity and prevalence of moderate and severe fatigue in TC survivors. Potential predictive factors, including physical activity, were explored.


A cross-sectional, written, self-administered TC patient survey and retrospective chart review were performed in an outpatient academic Endocrinology clinic in Toronto, Canada. The primary outcome measure was the global fatigue score measured by the Brief Fatigue Inventory (BFI). Physical activity was evaluated using the International Physical Activity Questionnaire-7 day (IPAQ-7). Predictors of BFI global fatigue score were explored in univariate analyses and a multivariable linear regression model.


The response rate was 63.1% (205/325). Three-quarters of the respondents were women (152/205). The mean age was 52.5 years, and the mean time since first TC surgery was 6.8 years. The mean global BFI score was 3.5 (standard deviation 2.4) out of 10 (10 is worst). The prevalence of moderate-severe fatigue (global BFI score 4.1-10 out of 10) was 41.4% (84/203). Individuals who were unemployed or unable to work due to disability reported significantly higher levels of fatigue compared to the rest of the study population, in uni-and multivariable analyses. Furthermore, increased physical activity was associated with reduced fatigue in uni- and multivariable analyses. Other socio-demographic, disease, or biochemical variables were not significantly associated with fatigue in the multivariable model.


Moderate or severe fatigue was reported in about 4/10 TC survivors. Independent predictors of worse fatigue included unemployment and reduced physical activity.


cancer survivorship; fatigue; physical activity; survey; thyroid cancer

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