Liuliu Zhang

Background and Objective: Voice impairment is common after thyroid cancer surgery and can significantly affect quality of life, even in the absence of recurrent laryngeal nerve (RLN) injury. Voice rehabilitation has been recognized as beneficial, but current guidelines lack thyroid cancer-specific protocols regarding assessment, timing, intensity, and long-term follow-up. This review critically appraises current evidence on voice rehabilitation after thyroid cancer surgery to inform clinical decision-making and identify practice gaps. Methods: PubMed and Web of Science Core Collection were searched from January 1, 2015 to July 31, 2026. Eligible studies included clinical decisions, guidelines, expert consensus, systematic reviews, and original clinical studies addressing postoperative voice assessment, rehabilitation, or follow-up in adults after thyroidectomy for thyroid cancer. Evidence was synthesized narratively across nine domains: mechanisms and natural history; assessment tools and timing; timing and risk stratification; voice therapy; surgical rehabilitation; special populations; tele-rehabilitation and long-term follow-up; multidisciplinary collaboration and patient education; and evidence gaps. Key Content and Findings: Post-thyroidectomy voice dysfunction is multifactorial and heterogeneous. Most patients improve within 3–6 months, but approximately 20% have persistent dysfunction at 1 year. Multidimensional assessment combining patient-reported outcomes, perceptual evaluation, acoustic measures, and laryngeal imaging is recommended. Early voice therapy within 4 weeks may improve outcomes. Surgical rehabilitation, including injection laryngoplasty (IL), laryngeal framework surgery, and recurrent laryngeal nerve reinnervation (RLNR), is indicated for persistent paralysis. Tele-rehabilitation and multidisciplinary care are promising but understudied. Evidence remains limited by heterogeneity, small sample sizes, and lack of standardized outcome measures. Conclusions: Voice rehabilitation after thyroid cancer surgery should be individualized, multidimensional, and initiated early for high-risk patients. Future research should prioritize core outcome sets (COSs), multicenter randomized trials, and validation of tele-rehabilitation and digital tools to improve long-term voice outcomes.

Objectives: This qualitative meta-synthesis aimed to interpret how cancer patients experience and manage parenting concerns, and to identify implications for family-centered psychosocial care. Design: A qualitative meta-synthesis was conducted. Methods: PubMed, Embase, Web of Science, Cochrane Library, CINAHL, EBSCO, ProQuest, China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Database were searched from inception to April 2025. Qualitative studies published in Chinese or English were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Data were synthesized using thematic synthesis. Results: Thirty-seven studies were included. Three analytical themes were generated: disrupted parental identity and layered threat appraisal under cancer-related uncertainty; protective parenting and family adaptation as relational resources; and unmet multidimensional needs for family-centered and developmentally tailored care. Together, these themes showed that parenting concerns among cancer patients involved not only emotional distress and perceived threats to children, but also protective efforts, meaning-making, family adaptation, and unmet needs for practical, communicative, informational, and psychosocial support. Conclusion: Parenting concerns among cancer patients represent a dynamic, relational process in which cancer-related uncertainty disrupts parental identity, activates layered threat appraisals about children and family continuity, and may also mobilize protective parenting and family adaptation. These findings suggest that oncology care should move beyond individual distress management and incorporate routine assessment of parenting concerns, developmentally appropriate parent–child communication support, practical caregiving assistance, family-level psychosocial referral, and genetic counseling when hereditary risk is relevant. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023424201 , identifier CRD42023424201.