Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for Low-Risk Thyroid Cancer.
Alexis G Antunez, Brandy R Sinco, Megan C Saucke, Kyle J Bushaw, Catherine B Jensen, Sophie Dream, Abbey L Fingeret, Masha J Livhits, Aarti Mathur, Alexandria McDow, Sanziana A Roman, Corrine I Voils, Justin Sydnor, Susan C Pitt, CHOiCE Collaborative (Comparing Health Outcomes in Cancer Experience)
Author Information
Alexis G Antunez: Brigham and Women's Hospital.
Brandy R Sinco: University of Michigan, Ann Arbor, MI.
Megan C Saucke: University of Wisconsin-Madison, Madison, WI.
Kyle J Bushaw: University of Wisconsin-Madison, Madison, WI.
Catherine B Jensen: University of Wisconsin-Madison, Madison, WI.
Sophie Dream: Medical College of Wisconsin, Milwaukee, WI.
Abbey L Fingeret: University of Nebraska, Omaha, NE.
Masha J Livhits: University of California-Los Angeles; Los Angeles, CA.
OBJECTIVE: To evaluate the relative importance of treatment outcomes to patients with low-risk thyroid cancer (TC). SUMMARY BACKGROUND DATA: Overuse of total thyroidectomy (TT) for low-risk TC is common. Emotions from a cancer diagnosis may lead patients to choose TT resulting in outcomes that do not align with their preferences. METHODS: Adults with clinically low-risk TC enrolled in a prospective, multi-institutional, longitudinal cohort study from 11/2019-6/2021. Participants rated treatment outcomes at the time of their surgical decision and again 9 months later by allocating 100 points amongst 10 outcomes. T-tests and Hotelling's T 2 statistic compared outcome valuation within and between subjects based on chosen extent of surgery (TT vs. lobectomy). RESULTS: Of 177 eligible patients, 125 participated (70.6% response) and 114 completed the 9-month follow-up (91.2% retention). At the time of the treatment decision, patients choosing TT valued the risk of recurrence more than those choosing lobectomy and the need to take thyroid hormone less ( P <0.05). At repeat valuation, all patients assigned fewer points to cancer being removed and the impact of treatment on their voice, and more points to energy levels ( P <0.05). The importance of the risk of recurrence increased for those who chose lobectomy and decreased for those choosing TT ( P <0.05). CONCLUSION: The relative importance of treatment outcomes changes for patients with low-risk TC once the outcome has been experienced to favor quality of life over emotion-related outcomes. Surgeons can use this information to discuss the potential for asthenia or changes in energy levels associated with total thyroidectomy.
References
Med Decis Making. 2016 Aug;36(6):714-25
[PMID: 26957566]
