Factors associated with physicians' recommendations for managing low-risk papillary thyroid cancer

Am J Surg. 2021 Jul;222(1):111-118. doi: 10.1016/j.amjsurg.2020.11.021. Epub 2020 Nov 12.

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.

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

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Clinical Decision-Making
  • Comorbidity
  • Endocrinologists / standards
  • Endocrinologists / statistics & numerical data
  • Female
  • Humans
  • Male
  • Medical Overuse / prevention & control
  • Medical Overuse / statistics & numerical data
  • Middle Aged
  • Patient Preference / statistics & numerical data
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Risk Assessment / methods
  • Risk Assessment / standards
  • Risk Assessment / statistics & numerical data
  • Surgeons / standards
  • Surgeons / statistics & numerical data
  • Surveys and Questionnaires / statistics & numerical data
  • Thyroid Cancer, Papillary / mortality
  • Thyroid Cancer, Papillary / therapy*
  • Thyroid Gland / pathology
  • Thyroid Gland / surgery
  • Thyroid Neoplasms / mortality
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / therapy*
  • Thyroidectomy / methods
  • Thyroidectomy / standards
  • Thyroidectomy / statistics & numerical data*
  • Tumor Burden
  • United States / epidemiology
  • Watchful Waiting / standards
  • Watchful Waiting / statistics & numerical data*
  • Young Adult