The Thyroid Cancer Modified Anxiety Scale (TC-MAX): Development and External Validation of a Thyroid Cancer Distress Instrument
Performance · Psychometric properties of TC-MAX (18 questions, 3 subscales)Result — go to the resultWeighted κ (agreement of severity ranges) 0.84Authors' conclusion
TC-MAX represents the first dedicated measure of anxiety in thyroid cancer. It exhibits robust psychometric properties in a vulnerable population, accounting for complex viewpoints.
Study context
- Population
- Patients with PTC
- Participants
- 148 vs 1,002
- Comparison
- Internal validation vs External validation
- Internal validationn = 148
- External validationn = 1,002
- Outcome
- Psychometric properties of TC-MAX (18 questions, 3 subscales)
Methodological detailsinternal and external validation, Development: literature review, expert panel (n = 4), patient focus groups (n = 10), pilot testing (n = 59), patient feedback (n = 4)
- Internal and external validation
- Development: literature review, expert panel (n = 4), patient focus groups (n = 10), pilot testing (n = 59), patient feedback (n = 4)
Performance
As reported in the abstract
Weighted κ (agreement of severity ranges)
0.84
P < 0.001
By group
Internal validation
- Cronbach's α
- 0.93
- Test-retest ICC
- 0.86
- Spearman's ρ vs Distress Thermometer
- 0.56
- Spearman's ρ vs HADS
- 0.52
- Spearman's ρ vs FACT-G
- −0.50
External validation
- Cronbach's α
- 0.94
- Test-retest ICC
- 0.87
- Spearman's ρ vs Distress Thermometer
- 0.54
- Spearman's ρ vs HADS
- 0.67
- Spearman's ρ vs FACT-G
- −0.62
Cronbach's α
Internal validation0.93
External validation0.94
Test-retest ICC
Internal validation0.86
External validation0.87
Spearman's ρ vs Distress Thermometer
Internal validation0.56
External validation0.54
Spearman's ρ vs HADS
Internal validation0.52
External validation0.67
Spearman's ρ vs FACT-G
Internal validation−0.50
External validation−0.62
- All construct validity correlations
- P < 0.001
Further findings
Surgery vs Active surveillance
| Outcome | Active surveillance | Surgery | MCID | P value |
|---|---|---|---|---|
| Anchor-based MCID: active surveillance vs surgery | 25.9 (SD ± 16.4) | 42.6 (SD ± 23.3) | 16.7 | P < 0.001 |
Thyroidectomy vs Hemithyroidectomy
| Outcome | Hemithyroidectomy | Thyroidectomy | MCID | P value |
|---|---|---|---|---|
| Anchor-based MCID: hemithyroidectomy vs thyroidectomy | 33.6 (SD ± 17.4) | 50.5 (SD ± 24.1) | 16.9 | P = 0.005 |
Original publication
The Thyroid Cancer Modified Anxiety Scale (TC-MAX): Development and External Validation of a Thyroid Cancer Distress Instrument. Thyroid. Published 11 August 2026. doi:10.
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