Papillary Thyroid Microcarcinoma—If It Is Such a Good Cancer, Why Operate?

Sawka, Anna M.; Goldstein, David P.

doi:10.1001/jamaoto.2018.4260

Cited by 3 publications

(10 citation statements)

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“…Moreover, 83% of respondents agreed that undergoing active surveillance was the best decision (26). Compared with that study, our present investigation is unique because we had a surgical group for comparison (27). We observed that the state anxiety score was higher in the active surveillance group than that in the surgery group.…”

Section: Discussionmentioning

confidence: 52%

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Yoshida

Horiuchi

Okamoto

2020

Thyroid

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Background: Clinical practice guidelines have endorsed both active surveillance and surgery as viable management options for papillary thyroid microcarcinoma (PTMC). However, patients' perceptions on the options have rarely been addressed. Methods: A cross-sectional survey was conducted on 50 patients with PTMC who were under either active surveillance (n = 20) or postoperative follow-up (n = 30). The primary outcome was anxiety, which was measured using the State-Trait Anxiety Inventory (STAI). A questionnaire that comprised six items about PTMCrelated symptoms and concerns, which were measured with a visual analog scale, was also administered. Cohen's d effect size was calculated to express group differences. Multiple regression analysis was used to examine the relationships between state anxiety and other variables. Results: The median age and observation period were 61.5 years (range, 40-83 years) and 4.1 years (range, 0-8.6 years), respectively. The female/male ratio was 38/12. Compared with the surgery group, the active surveillance group showed higher scores in both state anxiety and trait anxiety, with corresponding effect sizes of 0.55 (confidence interval [CI]-0.03 to 1.1; p = 0.068) and 0.63 (CI 0.02-1.2; p = 0.037), respectively. Trait anxiety (b = 0.83) and observation time (b =-1.57) were the significant predictors of state anxiety. Moderate effect sizes were observed for ''discomfort in the neck'' (-0.53; CI-1.11 to 0.04); ''weak voice'' (-0.46; CI-1.03 to 0.12); and ''nervous about neck appearance'' (-0.64; CI-1.23 to-0.07), in favor of active surveillance. Conclusions: State anxiety among patients with PTMC seemed to be a reflection of an individual's trait rather than management. Understanding the patients' view appears to be key to improve shared decision-making.

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Section: Discussionmentioning

confidence: 52%

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Yoshida

Horiuchi

Okamoto

2020

Thyroid

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“…When considered in the context of prior research in this area, the study by Sawka et al adds novel insights about the intersection of gender, fear, and treatment choice in patients with low-risk thyroid cancer. Recently, the evaluation of patient emotions, such as fear, related to thyroid cancer diagnosis, treatment choice, and survivorship has garnered increased attention .…”

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confidence: 99%

“…The results of the study by Sawka and colleagues have important implications for patients and surgeons navigating complex treatment decisions. Fear of surgery naturally provides motivation for patients to prefer nonsurgical management options such as AS.…”

mentioning

confidence: 99%

“…Fear of needing to take thyroid hormone replacement therapy was associated with pursuing AS. In the current study, although the fear of the surgery differed significantly between men and women, gender was not associated with treatment choice . Together, these findings illustrate that many factors, including emotions, influence patients’ treatment decisions.…”

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confidence: 99%

“…As clinicians examine the findings by Sawka and colleagues, understanding their results in the context of other cultures and settings is critical. The finding that more than three-quarters of Canadian participants chose AS is in stark contrast to the variable, but generally minimal, uptake of AS in the US, but is more congruent with the acceptance of AS in Asia.…”

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confidence: 99%

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Gaps in Treatment-Related Fears of Patients With Low-Risk Thyroid Cancer—The Gender Divide

Jackson

Underwood

Pitt

2023

JAMA Otolaryngol Head Neck Surg

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et al 1 share results from a single-institution prospective, observational cohort study (NCT04624477) investigating the association between self-reported gender (treated as a binary variable) and fears associated with treatment options for low-risk papillary thyroid cancer (PTC). The 200 enrolled participants (153 women; 47 men) with untreated, clinically low-risk PTC (defined as <2 cm and confined to the thyroid) completed validated and original measures assessing fear of disease progression, fear of surgery, and thyroidectomy-specific fears prior to being offered surgery or active surveillance (AS). All participants had a surgical consultation to discuss the recommended extent of surgery and potential complications. Overall, 78% of participants chose AS, with no gender-related differences in treatment choice. However, enrolled participants who identified as women were significantly younger, and both age and gender were associated with fear of progression and fear of surgery on unadjusted models. After adjusting for age, those identifying as women had greater fear of surgery compared with men, but similar fears of progression and thyroidectomy-related fears. These findings are congruent with the similar rate of enrollment in AS by gender and have notable implications for patients and clinicians. Decisional confidence and self-efficacy were also evaluated, but no differences were seen.When considered in the context of prior research in this area, the study by Sawka et al 1 adds novel insights about the intersection of gender, fear, and treatment choice in patients with lowrisk thyroid cancer. Recently, the evaluation of patient emotions, such as fear, related to thyroid cancer diagnosis, treatment choice, and survivorship has garnered increased attention. 2 This attention comes in the wake of modern models of decisionmaking that recognize (1) the strong influence that emotions have on human judgment, and (2) the potential for emotions such as fear to drive seemingly irrational behavior that could result in unwanted outcomes. For example, data show that despite an excellent prognosis, survivors with favorable, low-risk thyroid cancer experience significant worry about disease recurrence, which can impair quality of life. 3 Gender effects must also be considered in relation to sex-based disease disparities. The prevalence of thyroid cancer remains 3 times higher in women who are more likely to be diagnosed with small PTCs. 4 Despite these differences, limited investigation exists into how sex and gender influence thyroid cancer-related information processing and decision-making.The results of the study by Sawka and colleagues 1 have important implications for patients and surgeons navigating complex treatment decisions. Fear of surgery naturally provides motivation for patients to prefer nonsurgical management options such as AS. At the same time, fear and anxiety associ- Related articleGaps in Treatment-Related Fears of Patients With Low-Risk Thyroid Cancer-The Gender Divide Invited Commentary jamaotolaryngology.c...

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Degree of Cancer Worry Is No Worse in Thyroid Cancer Patients Undergoing Active Surveillance than in Treated Patients

OrloffLisa

2019

Clinical Thyroidology

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Papillary Thyroid Microcarcinoma—If It Is Such a Good Cancer, Why Operate?

Cited by 3 publications

References 9 publications

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Gaps in Treatment-Related Fears of Patients With Low-Risk Thyroid Cancer—The Gender Divide

Degree of Cancer Worry Is No Worse in Thyroid Cancer Patients Undergoing Active Surveillance than in Treated Patients

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