Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for Low-Risk Thyroid Cancer.

Autor:	Antunez AG; Brigham and Women's Hospital., Sinco BR; University of Michigan, Ann Arbor, MI., Saucke MC; University of Wisconsin-Madison, Madison, WI., Bushaw KJ; University of Wisconsin-Madison, Madison, WI., Jensen CB; University of Wisconsin-Madison, Madison, WI., Dream S; Medical College of Wisconsin, Milwaukee, WI., Fingeret AL; University of Nebraska, Omaha, NE., Livhits MJ; University of California-Los Angeles; Los Angeles, CA., Mathur A; Johns Hopkins University, Baltimore, MD., McDow A; Indiana University, Indianapolis, IN., Roman SA; University of California - San Francisco; San Francisco, CA., Voils CI; William S. Middleton Memorial Veterans Hospital, Madison, WI., Sydnor J; University of Wisconsin-Madison, Madison, WI., Pitt SC; University of Michigan, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 May 20. Date of Electronic Publication: 2024 May 20.
DOI:	10.1097/SLA.0000000000006347
Abstrakt:	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. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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