Quality of Life in Chinese Youth Following Open Thyroid Surgery

Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age. 12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health. 15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media. After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL. 22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer. 1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes. 24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy. This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults. 8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors. 28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age. 12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health. 15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media. After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL. 22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer. 1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes. 24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy. This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults. 8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors. 28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age. 12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health.15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28Background Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.Globally, thyroid cancer (TC) is the ninth most common malignancy and the most common endocrine cancer.1 Conventional thyroidectomy remains the preferred procedure for the most common pathologies, cancers, goiters of all categories, and any other thyroid disorders that cannot be resolved with medication.2 Surgical intervention includes an incision in the neck to directly access and remove the thyroid gland,3 which leaves a "suicide" incision scar in the anterior neck area.4 The most common type of TC is differentiated TC, and 30% to 90% of differentiated TC patients have lymph node metastasis in the neck. For patients with image and/or histologically confirmed lymph node neck metastasis, surgery involves the central region and selective lymph node dissection across the lateral cervical region.5 Traditional surgery mostly uses L-shaped incision, which has a large postoperative scar and greatly affects aesthetics.6 Biophysiological differences in Asian populations predispose postsurgical, hyperpigmentation, and scar formation, which generally affects the patient's quality of life (QoL).7In most countries, the incidence of TC is on the rise among young adults.8 The National Cancer Institute defines patients diagnosed with cancer between the ages of 15 and 39 years as adolescent and young adult cancer patients,9 which Chinese researchers translate as young adult cancer patients.10 Because of health screening, early diagnosis of disease has increased significantly. This is significant because younger patients are more concerned about physical changes when compared with older patients.11 The results of a survey of Chinese citizens' perceptions of beauty suggest that youth are more affected by beauty standards, and there is a decreasing trend of approval with age.12 In addition, young people face significant life stage changes (study, employment, and marriage); therefore, our focus remains on experiences in younger patients.With such a positive survival prognosis of TC,13 it is important to understand the longer-term effects of thyroidectomy on patients. These include scar formation, restrictions on clothing choices, establishing relationships, and managing self and others' reactions after diagnosis and treatment.14 Many people experience scarring after surgery or trauma, and size, shape, and location on the body have a potential impact on their physical, social, and psychological health. 15,16 One study linked "fear of scarring" as the second most common adverse event postthyroidectomy,17 with visible scars causing increased emotional/social anxiety and self-consciousness.18 Up to 19% of thyroidectomy patients report concerns about scarring 1 year after surgery, with 33% reporting dissatisfaction because of neck scars.19 This was linked to increased levels of anxiety and depression and substantial decrease in QoL.19 In fact, studies on self-reported health-related QoL in TC patients are comparable with those on other cancer patients who received poorer prognosis.20,21Therefore, the positive prognosis for most TCs (especially in younger patients) means we must focus on their ongoing QoL.22 The long-term goal of TC treatment is not only to reduce distant tumor recurrence and improve patient outcomes, but also to focus on the patient QoL. Thus, further research is needed to reveal how scarring and other factors impact these patients' QoL.This is relevant today because there are alternatives. Minimally invasive, "scarless" techniques are available23 and offer improved cosmetic outcomes.24 Thus, it is important to understand the experiences of postthyroidectomy TC survivors to inform healthcare professionals on provision of evidence-based, appropriate care.25Patient-reported outcomes are increasingly important in research and clinical care and can complement traditional surgical outcomes.26 However, there is sparse evidence on the impact of surgical intervention and scarring on patient-reported QoL.Thus, this article presents a qualitative study to offer insight into scar characteristics, symptoms, and their impact on QoL in young Chinese TC patients after conventional thyroidectomy.This study used a qualitative descriptive design and directed content analysis using guiding themes to discover the characteristics of postoperative scars and their impact on QoL in young TC patients and followed COREQ (Consolidated Criteria for Reporting Qualitative Research).27 Directed content analysis offers a deductive approach to build upon existing theoretical and evidence basis: that postoperative scarring is linked with impaired QoL. It offers an iterative coding mechanism based on the existing theories that indicate there are postoperative factors that affect QoL in cancer survivors.28