Perception of risk and treatment decisions in the management of differentiated thyroid cancer

Background and Objectives The recent de‐escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC. Methods Thyroid specialists were surveyed with...

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Bibliographic Details
Published in:Journal of surgical oncology 2022-08, Vol.126 (2), p.247-256
Main Authors: Schumm, Max A., Shu, Michelle L., Kim, Jiyoon, Tseng, Chi‐Hong, Zanocco, Kyle, Livhits, Masha J., Leung, Angela M., Yeh, Michael W., Sacks, Greg D., Wu, James X.
Format: Article
Language:English
Subjects:
behavioral science
decision‐making
Perceptions
risk and benefit
Surveillance
Thyroid cancer
thyroid surgery
thyroidectomy
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Summary:Background and Objectives The recent de‐escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC. Methods Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC. Participants judged the operative risks and likelihood of structural cancer recurrence associated with more versus less aggressive treatments. A logistic mixed effect model was used to predict treatment choice. Results Among 183 respondents (13.4% response rate), 44% were surgical and 56% medical thyroid specialists. Risk estimates and treatment recommendation varied markedly in each case. Respondents' estimated risk of 10‐year cancer recurrence after lobectomy for a 2.0‐cm PTC ranged from 1% to 53% (interquartile range [IQR]: 3%–12%), with 66% recommending lobectomy and 34% total thyroidectomy. Respondents' estimated 5‐year risk of metastastic disease during active surveillance of an 0.8‐cm mPTC ranged from 0% to 95% (IQR: 4%–15%), with 36% choosing active surveillance. Overall, differences in perceived risk reduction explained 10.3% of the observed variance in decision‐making. Conclusions Most of the variation in thyroid cancer treatment aggressiveness is unrelated to perceived risk of cancer recurrence.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.26858