BACKGROUND
There has been a rise in the number of patients with thyroid cancer in the United States. A large number of these new cases are small thyroid cancers which are limited to the thyroid gland and do not show evidence of having spread to the lymph nodes of the neck. Fortunately, the prognosis is excellent, as the death rates for thyroid cancer have remained very low, with approximately 0.4 deaths per 100,000 patients, and rates are even lower for the very small cancers that are limited to the thyroid gland.

The usual treatment for thyroid cancer has been thyroid surgery. However, the option following certain small low risk papillary cancers with ultrasound and deferring surgery, known as active surveillance, has been described as an alternative to surgical treatment by some groups in Japan, and, more recently, in the United States. However, and in spite of the growing acceptance of this approach as a suitable option for management of selected patients with thyroid cancer, it is not very clear what are the rates of use of active surveillance in the United States, outside of selected centers.

This study was done in order to understand physicians’ attitudes toward use of active surveillance, how often it is being used, and what are the barriers to its use in a diverse group of physicians who treat thyroid cancer patients in the general population.

THE FULL ARTICLE TITLE
Hughes DT et 2022 Barriers to the use of active surveillance for thyroid cancer: Results of a physician survey. Ann Surg 276(1):e40–e47. PMID: 33074908.

SUMMARY OF THE STUDY
Surgeons and endocrinologists identified as having treated patients who participated in the SEERS (Surveillance, Epidemiology and End Results) registries in Georgia and Los Angeles were surveyed during 2018 and 2019. A total of 654 physicians received surveys, and there were 448 responders (69%). The surveys included questions such as:

• Is active surveillance an appropriate action for some patients with thyroid cancer?
• Do you recommend active surveillance of thyroid cancer patients?
• What are barriers to active surveillance?

Of the physicians who responded, 30% were general surgeons; 28% were ENT specialists and 42% were endocrinologists.

The majority of physicians (76%) believed that active surveillance was an appropriate management option but only 44% used it in their practice. Physicians reported multiple barriers to using active surveillance such as: patient refusal (80.3%), concern about loss to follow up (78.4%), patient worry (57.6%) and concerns about malpractice lawsuits (50.9%).

Physicians who practice in an academic center were more likely to accept the use of active surveillance. Physicians who accepted that active surveillance was appropriate but did not use in their practice were more likely to have been more years in practice and have greater patient volume.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study is innovative because it focuses on the influence of physician factors and physician perception of patient factors on the acceptance of and use of active surveillance for thyroid cancer. This study is important to patients because there has been a shift from more to less intensive management for thyroid cancer and therefore, the concept of active surveillance has gained attention. Although physicians managing thyroid cancer have widely accepted active surveillance as an appropriate management option, less than half of them offer it to their patients. Understanding and addressing the different barriers to its use is key to increasing availability of this management option.

— Jesse Block-Galaraza, MD

Table of Contents | PDF File for Saving and Printing