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Journal Article Ppublish 2 citations

PubMed: 40044452 DOI: 10.1002/wjs.12520

Risk of Cancer Recurrence Exerts the Strongest Influence on Choice Between Active Surveillance and Thyroid Surgery as Initial Treatment for Low-Risk Thyroid Cancer: Results of a Discrete Choice Experiment.

World J Surg 49(5):1254-1263

Authors: Jacob Hampton, Gavin Cooper, Laura Wall, Christopher Rowe, Nicholas Zdenkowski, Elizabeth Fradgley, Julie Miller, Jenny Gough, Scott Brown, Christine O'Neill

Affiliations

  • Surgical Services John Hunter Hospital, Newcastle, Australia.
  • School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
  • Hunter Medical Research Institute, Newcastle, Australia.
  • School of Psychological Sciences, University of Newcastle, Newcastle, Australia.
  • Department of Endocrinology, John Hunter Hospital, Newcastle, Australia.
  • Department of Surgery, The Royal Melbourne Hospital, Melbourne, Australia.
  • Department of Surgery, Wesley Hospital, Brisbane, Australia.

Abstract

BACKGROUND

Treatment options for low-risk differentiated thyroid cancer (DTC) include active surveillance (AS), hemithyroidectomy (HT), or total thyroidectomy (TT). Improved understanding of patient values and preferences is required to inform shared decision-making. This study examined factors influencing patient treatment preferences and trade-offs for low-risk DTC.

METHODS

Adult participants with benign thyroid nodules or low-risk DTC completed an online discrete choice experiment (DCE). Utilizing the scenario of a 50-year-old person with a small solitary DTC, participants chose between three unlabeled treatment options (representing AS, HT, and TT). Risk profiles varied across 5 domains: voice change, thyroid hormone supplementation, hypocalcaemia, chance of future thyroid surgery, and 10-year risk of cancer recurrence. Participants self-reported demographics, disease factors, and answered a decisional regret scale. A conditional logit model was utilized.

RESULTS

The DCE was completed by 143 patients across three sites. The conditional logit model demonstrated that participants preferred AS (49%) over TT (29%) or HT (22%). All five domains influenced choices (all p < 0.001), but perceived risk of cancer recurrence exerted most influence. Cancer survivors chose AS less often than those with benign disease (46% vs. 57%), driven by perceived risks of further surgery and cancer recurrence. As the perceived risk of cancer recurrence increased, more participants preferred HT over AS.

CONCLUSION

This study demonstrates that when blinded to the actual treatment, patients prefer the trade-offs associated with AS rather than TT or HT. Perceived risk of cancer recurrence exerted the greatest influence. Accurate risk stratification for cancer recurrence is critical to shared decision-making.

MeSH

Neoplasms, Thyroid Gland, Thyroid Neoplasms, Therapeutics, Thyroidectomy, General Surgery