Systematic adolescent-centered supportive care program is associated with improved psychological status, treatment adherence, and social adaptation in adolescents with thyroid cancer undergoing radioiodine-131 therapy: a retrospective before-after cohort study with historical controls

Abstract

Background Adolescents and young adults (AYAs) with differentiated thyroid cancer (DTC) undergoing radioiodine-131 (131I) therapy endure unique developmental and psychosocial challenges, yet evidence for adolescent-tailored supportive interventions remains scarce. This retrospective before-after cohort program is associated with improvements in psychological distress, treatment adherence, and social reintegration. Methods We enrolled 220 eligible patients aged 13–25 years with DTC receiving131I therapy (2016-2024). The control group (n=85) received routine care, while the observation group (n=135) received a multi-component supportive care program. It included narrative medicine interviews, radiation education, fertility and career counseling, social adaptation training, and sustained follow-up. Primary outcomes were anxiety (SAS) and depression (SDS) scores. Secondary outcomes covered adherence, social adaptation, fertility cognition and satisfaction. Linear mixed-effects models analyzed repeated SAS/SDS data; propensity score inverse probability weighting(IPTW), multivariable regression and Benjamini–Hochberg FDR correction were applied to adjust confounders and handle multiple comparisons. Results In linear mixed-effects models, the observation group exhibited significantly lower 6-month SAS and SDS scores (all adjusted P < 0.001).Significant group×time interactions for both scales demonstrated sustained psychological improvements. In multivariable logistic regression analyses adjusting for potential confounders, the observation group also achieved superior treatment adherence( aOR=2.71 ,95%CI:(1.52–4.83), school/work resumption rates (aOR=2.35,95%CI:1.22−4.51), and medical satisfaction (aOR=2.01,95%CI:1.11−3.64) (allFDR−P<0.05).IPTW sensitivity analyses corroborated these findings. Exploratory subgroup analyses did not reveal consistent evidence of differential intervention effects across most subgroups. Conclusion A standardized adolescent-centered supportive care program was associated with persistent anxiety and depression relief, improved adherence and social reintegration among AYAs with DTC receiving 131I therapy. While these real-world findings support program feasibility, prospective multicenter randomized trials are required to confirm causal efficacy.