Factors associated with physicians’ recommendations for managing low-risk papillary thyroid cancer - 15/06/21

Doi : 10.1016/j.amjsurg.2020.11.021

Alexandria D. McDow ^a,^⁎ , Benjamin R. Roman ^b , Megan C. Saucke ^c , Catherine B. Jensen ^c , Nick Zaborek ^d , Jamia Linn Jennings ^e , Louise Davies ^f , Juan P. Brito ^g , Susan C. Pitt ^c
^a Division of Surgery Oncology, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 537, Indianapolis, IN, 46202, USA
^b Division of Head and Neck, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
^c Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA
^d Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI, 53792, USA
^e Wisconsin Department of Health Services, 1 West Wilson Street, Madison, WI, 53703, USA
^f The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, USA and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, 1 Medical Center Drive, Lebanon, NH, 03756, USA
^g Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

^∗Corresponding author. Indiana University School of Medicine, Department of Surgery - Division of Surgical Oncology, 545 Barnhill Drive EH 537, Indianapolis, IN, 46202, USA.Indiana University School of MedicineDepartment of Surgery - Division of Surgical Oncology545 Barnhill Drive EH 537IndianapolisIN46202USA

Abstract

Background

The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians’ recommendations for LR-PTC.

Methods

We surveyed members of three professional societies and assessed respondents’ recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS).

Results

The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians’ preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS.

Conclusions

Physicians’ recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.

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Highlights

•	Physician recommendations for low-risk papillary thyroid cancer are multifactorial.
•	Physicians’ personal treatment preference is associated with their recommendations.
•	Physician specialty and stated patient preference also influence recommendations.

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Keywords : Thyroid cancer, Overtreatment, Low-risk, Active surveillance, Survey, Thyroidectomy

Plan

Introduction

Materials and methods

Study population

Survey administration

Instrument development

Statistical analysis

Results

Demographics

Clinical factors affecting management recommendations

Non-clinical factors affecting management recommendations

Discussion

Conclusion

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Vol 222 - N° 1

P. 111-118 - juillet 2021 Retour au numéro

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Factors associated with physicians’ recommendations for managing low-risk papillary thyroid cancer - 15/06/21

Abstract

Background

Methods

Results

Conclusions

Highlights

Plan

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