Ethical issues in non-intervention trials for thyroid cancer

Abstract

In recent years, the increasing numbers of small, apparently indolent thyroid cancers diagnosed in the world have encouraged investigators to consider non-intervention as an alternative to surgical management. In the following pages, the prospect of a non-intervention trial for thyroid cancer is considered with attention to the ethical issues that such a trial might raise. Such a non-intervention trial is analyzed relative to 7 ethical considerations: the social or scientific value of the research, the scientific validity of the trial, the necessity of fair selection of participants, a favorable risk-benefit ratio for trial participants, independent review of the trial, informed consent, and allowing the study participants to withdraw from the trial. A non-intervention trial for thyroid cancer is also considered relative to the central concept of equipoise.

Active surveillance for PTMC warranted for the UK population?

“…Active surveillance has been found to be extremely effective in selected populations when performed by groups with high levels of experience. Whether such an approach would translate to UK centres and whether such an approach would be acceptable to a UK population remain to be seen 31 . However, even more critical is that during a time where practice guidelines are increasingly influential, updated iterations of such documents continue to support an approach to incidental thyroid nodules which minimises the requirement to further investigate patients who have an extremely low risk of harbouring clinically significant disease.…”