Papillary thyroid carcinoma (PTC) is the predominant form of thyroid cancer, which accounts for nearly 85% of all thyroid cancer cases (Megwalu and Moon, 2022). Currently, the primary treatment strategy for PTC patients is surgery (including lobectomy, thyroidectomy, neck dissection, etc.; McDow et al., 2021; Ngo et al., 2021; Sanabria et al., 2022); followed by thyroid hormone therapy, radioactive iodine therapy, targeted therapy, etc. (Kim et al., 2020; Hescheler et al., 2021; Chan and Kwong, 2022). Benefiting from the advancements of these treatments, the prognosis of PTC patients is favorable with a 10-year overall survival (OS) rate more than 90% (Ito et al., 2018; Harries et al., 2020; Jukic et al., 2022). However, PTC patients usually suffer from a huge psychological burden and the PTC-induced thyroid hormones dysregulation may aggravate the psychological issues, including anxiety, depression, etc., as well as reduce the quality of life in PTC patients (Banihashem et al., 2020; Baksi and Pradhan, 2021; Liu and Brent, 2021). Meanwhile, older PTC patients usually possess a worse prognosis compared to younger patients, which may also affect their mental health and quality of life (Kaliszewski et al., 2020; Sun et al., 2020). Therefore, it is imperative to explore effective strategies to improve psychological health and quality of life in older PTC patients.

Reminiscence therapy (RT) is a kind of psychotherapy aiming to ameliorate the psychological status and quality of life by recalling and sharing wonderful past memories, which is generally applied to patients with neurological diseases, such as Alzheimer’s disease (AD), dementia, acute ischemic stroke (AIS), etc. (Hsiao et al., 2020; Li et al., 2020; Cheng et al., 2021; Li and Liu, 2022; Perez-Saez et al., 2022). At present, this intervention is also widely used in cancer patients to improve their mental health and quality of life (Liu and Li, 2021; Zhang et al., 2021). For instance, a study reports that RT is effective in decreasing anxiety and improving the quality of life in gastric cancer patients (Zhang et al., 2021). Meanwhile, RT is also helpful in ameliorating anxiety, depression, and quality of life in non-small cell lung cancer (NSCLC) patients (Liu and Li, 2021). Moreover, anxiety, depression, and quality of life are all relieved, and OS is also prolonged to some extent in colorectal cancer patients receiving RT compared with those receiving control care (Zhou and Sun, 2021). Therefore, it could be speculated that RT may be also effective in improving mental health and quality of life in older PTC patients. Nevertheless, the effect of RT in these patients has not been investigated yet.

Accordingly, this randomized, controlled study designed an RT-care program (RT-CP), intending to investigate the effect of RT-CP on psychological health and quality of life in older PTC patients.

In recent years, RT has achieved a lot of attention for mitigating anxiety and depression in cancer patients (Zhao, 2021; Huang et al., 2022). A study claims that RT is effective for glioma patients to reduce anxiety and depression (Zhao, 2021). Besides, RT could serve as a potential nursing intervention for attenuating anxiety and depression in prostate cancer patients (Huang et al., 2022). However, the potency of RT in older PTC patients requires to be explored. This study discovered that anxiety and depression were attenuated to some extent in the RT-CP group compared with the U-CP group. The potential reasons might be that: (Megwalu and Moon, 2022) RT-CP encouraged older PTC patients to recall and share past positive memories, which would make them feel valued and connected (Liu and Li, 2021; Zhao, 2021; Sanabria et al., 2022) older PTC patients were likely to develop negative emotions, such as lonely, abandoned, unhappy, self-isolated, etc., while RT-CP allowed them to share pleasant memories with others, which helped these patients to regain hope, confidence, and self-esteem, thus helping them to have an optimistic mindset towards life (Li et al., 2022). Thereby RT-CP could eliminate anxiety and depression to some extent in older PTC patients. Moreover, anxiety rate and depression rate were only slightly decreased in the RT-CP group by comparison with the U-CP group but did not reach statistical significance. The potential argument would be that: the sample size was relatively insufficient in this study, which led to low statistical power.

In addition to anxiety and depression, RT also plays an essential role in improving the quality of life in cancer patients, including patients with NSCLC, gastric cancer, glioma, colorectal cancer, etc. (Liu and Li, 2021; Zhang et al., 2021; Zhao, 2021; Zhou and Sun, 2021). This study observed that: (Megwalu and Moon, 2022) RT-CP could improve the global health status to a certain extent in older PTC patients. The possible reason might be that: as mentioned above, RT-CP allowed older PTC patients to share wonderful memories with other patients, which would help patients to rebuild self-identity, enhance social ability, make new friends, and trigger the aspiration for a better life (Liu and Li, 2021; Zhang et al., 2021; Zhao, 2021); all of these helped them to build a positive attitude towards life, and might further improve the quality of life. (Sanabria et al., 2022) RT-CP could also enhance the function score to some extent. The possible explanation would be that: as discussed above, RT-CP could improve patients’ mental health by recalling and sharing pleasant memories with others, which helped them to restore emotional, cognitive, and social functions; additionally, RT-PC also provided health education, which might assist patients in restoring physical and role functions (Liu and Li, 2021; Zhao, 2021; Zhou and Sun, 2021; Li et al., 2022). Taking these together, the function score was also increased in the RT-CP group compared to the U-CP group. (McDow et al., 2021) The symptom score was decreased in the RT-CP group in contrast with the U-CP group. The possible argument would be that: RT-CP helped patients to interact with others, which might allow them to better understand how to deal with symptoms, including fatigue, pain, nausea, and vomiting (Zhao, 2021; Huang et al., 2022; Li et al., 2022). However, health education was also provided in the U-CP group. Hence, RT-CP could only reduce symptom scores to some extent in older PTC patients compared to U-CP.

Meanwhile, this study also explored the effect of RT-CP on survival in older PTC patients. It was found that DFS and OS were not different between the RT-CP group and the U-CP group. The possible argument would be that: the determinants of prognosis mainly included age, tumor size, metastasis, thyroid gland invasion, etc.; therefore, the improvement of mental health and quality of life might have a minor or even no effect on the survival profile in older PTC patients (Shin et al., 2020; Sun et al., 2020).

Further subgroup analysis suggested that the effect of RT-CP was more obvious in female, single/divorced/widowed, and pTNM stage of I/II older PTC patients. The potential reasons would be that: (Megwalu and Moon, 2022) female and single/divorced/widowed patients were more likely to suffer from emotional or psychological problems, such as anxiety and depression (Hald et al., 2022); as discussed above, RT-CP could effectively ameliorate anxiety and depression; thus, anxiety and depression were decreased in female, single/divorced/widowed patients receiving RT-CP compared to those receiving U-CP; (Sanabria et al., 2022) the disease conditions were complicated and severe in patients with higher pTNM stage, indicating that the dysregulation of thyroid hormones was more aggravated; therefore, brain function might be gravely affected, which would reduce the effect of RT-CP in these patients (Gobel et al., 2020). As a result, RT-CP could only attenuate HADS-A score in older PTC patients with pTNM stage of I/II.

Notably, considering that premorbid anxiety and depression would affect postoperative mental issues, it was necessary to make a clear statement to clarify this issue. (Megwalu and Moon, 2022) This problem had been noticed before the current research started; therefore, the corresponding exclusions were set for patients who had mental diseases (including anxiety and depression), and for patients who had documented diagnoses of anxiety and depression before surgery. (Sanabria et al., 2022) To avoid further misunderstanding, it also should be noticed that this study only excluded patients who had documented diagnoses of anxiety and depression, while did not exclude patients who had symptoms of anxiety and depression before the surgery. Since the base of older PTC patients is relatively fewer compared with young adults, and if the patients who had preoperative symptoms of anxiety and depression were strictly excluded, then the number of eligible subjects would be very small.

Several limitations should be noticed in this study: (Megwalu and Moon, 2022) the follow-up duration was not long enough; thus, the long-term effect of RT-CP on improving anxiety, depression, and quality of life in older PTC patients should be further explored; (Sanabria et al., 2022) this was a single-center study; therefore, selection bias might exist; (McDow et al., 2021) HADS score was self-assessed; therefore, assessment bias would exist in this study.

In summary, RT-CP may be a potential intervention for ameliorating anxiety and depression, as well as improving the quality of life, while it has no effect on prolonging survival in older PTC patients. Clinically, RT-CP as a non-pharmacological intervention can be effective in improving psychiatric problems and quality of life in older PTC patients; however, the intervention approach taken in this study is conducted in a group setting; thus, whether the individual model of this intervention is equally effective or more effective for older PTC patients requires further research to verify.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by Ethics Committee of Harbin Medical University Cancer Hospital. The patients/participants provided their written informed consent to participate in this study.

YL conceived and designed the experiment, analyzed the data, and revised the manuscript. LC collected and analyzed the data. XY performed data analysis and provided interpretation. XR provided technical support and analyzed and interpreted the results. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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