Challenges of Active Surveillance Protocols for Low-Risk Papillary Thyroid Microcarcinoma in the United States

Gc, Haser; Rm, Tuttle; Ml, Urken

doi:10.1089/thy.2016.0109

Cited by 15 publications

(6 citation statements)

References 5 publications

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“…As a result, active surveillance (AS) instead of immediate surgery has been suggested as an alternative management approach for low-risk PTMCs [3]. AS involves a life-long regular followup of the PTMC status with appropriate surgical treatment provided only when disease progression becomes apparent [4][5][6]. Since the introduction of AS for PTMCs by Japanese surgeons [3], many retrospective observational studies have suggested that this is a safe and effective approach for the management of low-risk PTMCs [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma

et al. 2021

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Background: A Korean Multicenter Prospective cohort study of Active Surveillance or Surgery (KoMPASS) for papillary thyroid microcarcinomas (PTMCs) has been initiated. The aim is to compare clinical outcomes between active surveillance (AS) and an immediate lobectomy for low-risk PTMCs. We here outline the detailed protocol for this study. Methods: Adult patients with a cytopathologically confirmed PTMC sized 6.0 to 10.0 mm by ultrasound (US) will be included. Patients will be excluded if they have a suspicious extra-thyroidal extension or metastasis of a PTMC or multiple thyroid nodules or other thyroid diseases which require a total thyroidectomy. Printed material describing the prognosis of PTMCs, and the pros and cons of each management option, will be provided to eligible patients to select their preferred intervention. For the AS group, thyroid US, thyroid function, and quality of life (QoL) parameters will be monitored every 6 months during the first year, and then annually thereafter. Disease progression will be defined as a ≥3 mm increase in maximal diameter of a PTMC, or the development of new thyroid cancers or metastases. If progression is detected, patients should undergo appropriate surgery. For the lobectomy group, a lobectomy with prophylactic central neck dissection will be done within 6 months. After initial surgery, thyroid US, thyroid function,

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Section: Introductionmentioning

confidence: 99%

Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma

et al. 2021

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“…New data on patient outcomes and protocols for active surveillance have also been published in the interim. [4][5][6][23][24][25][26] Nonetheless, this study is the rst we are aware of to qualitatively highlight the role of physician attitudes and beliefs in adoption of active surveillance in the US.…”

Section: Discussionmentioning

confidence: 98%

“…Patient expectations and societal beliefs about cancer were also commonly described barriers to implementation. Interventions to address some of these barriers are already underway, including establishing outcomes of active surveillance in US patients 8,9 , publication of protocols [23][24][25][26][27] , and physician education. Additional interventions should focus on physicians' and patients' beliefs about cancer, facilitating multidisciplinary approaches, and promoting societal-level acceptance of active surveillance.…”

Section: Discussionmentioning

confidence: 99%

Active Surveillance for Thyroid Cancer: A Qualitative Study of Barriers and Facilitators to Implementation

Jensen

Saucke

Pitt

2021

Preprint

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Background: The 2015 American Thyroid Association guidelines supported active surveillance (AS) as a strategy for managing select low-risk thyroid cancers. Data examining physicians’ attitudes about the acceptability of this option are limited. This study aimed to characterize the barriers and facilitators to implementing AS as perceived by practicing endocrinologists and surgeons in the United States.Methods: We conducted 24 semi-structured interviews probing physicians’ attitudes toward AS for patients with small, low-risk thyroid cancer. We used deductive content analysis guided by a well-known model of guideline implementation. Analysis characterized concepts and themes related to AS implementation as physician, guideline, or external factors. We performed member checking to validate results.Results: The most prominent barriers to AS were related to physician factors , although guideline-specific and external barriers were also observed. Physician attitudes towards AS comprised the majority of physician-related barriers, while lack of knowledge about the guideline was also discussed. Participants’ concerns about the potential negative outcomes resulting from observing a cancer were notable as were the lack of confidence in performing and offering surveillance. Beliefs about patient expectations and lack of knowledge about the guideline were also identified as barriers to offering surveillance. Guideline-specific and external barriers included the vagueness of surveillance protocols, lack of data supporting active surveillance, and societal beliefs about cancer. Facilitators of active surveillance included patients’ desire to avoid surgery and shared decision-making.Conclusions: Barriers and facilitators of active surveillance for low-risk thyroid cancers exist at multiple levels. Strategies to increase adoption of active surveillance should focus on physicians’ attitudes, patient expectations, data supporting surveillance outcomes, and promoting societal-level acceptance of surveillance.

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“…If patients are expected to be lost during follow-up, AS is not a good option for them. Haser et al [ 28 ] suggested the following important points regarding AS of PTMC to provide continuity of care as patients move or change physicians/hospitals, to store US data in a detailed and uniform format to identify and report changes readily, to educate clinicians and patients about entry/exclusion criteria and follow-up, to evaluate patients' QoL during AS, and to conduct research on outcomes for patients undergoing AS.…”

Section: Clinical Application Of Active Surveillancementioning

confidence: 99%

Active Surveillance of Papillary Thyroid Microcarcinoma: A Mini-Review from Korea

Kim

Shong

2017

Endocrinol Metab

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In Korea, the incidence of thyroid cancer increased explosively in the early 2000s, and reached a plateau in the early 2010s. Most cases of newly diagnosed thyroid cancer are small indolent microcarcinoma and could be good candidates for active surveillance (AS) instead of immediate surgery. Many considerations must be taken into account for establishing selection criteria for candidates for AS of papillary thyroid microcarcinoma (PTMC), including the characteristics of the tumor, the patient, and the medical team. If possible, AS of PTMC should be a part of a prospective clinical trial to ensure long-term safety and to identify clinical and/or molecular markers of the progression of PTMC. In this review, we discuss lessons regarding surgical interventions for PTMC, and then describe the concept, application, caveats, unanswered questions, and future perspectives of AS of PTMC. For appropriately selected patients with PTMC, AS can be a good alternative to immediate surgery.

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Challenges of Active Surveillance Protocols for Low-Risk Papillary Thyroid Microcarcinoma in the United States

Cited by 15 publications

References 5 publications

Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma

Protocol for a Korean Multicenter Prospective Cohort Study of Active Surveillance or Surgery (KoMPASS) in Papillary Thyroid Microcarcinoma

Active Surveillance for Thyroid Cancer: A Qualitative Study of Barriers and Facilitators to Implementation

Active Surveillance of Papillary Thyroid Microcarcinoma: A Mini-Review from Korea

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