Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery

Abstract

Background: Clinical practice guidelines have endorsed both active surveillance and surgery as viable management options for papillary thyroid microcarcinoma (PTMC). However, patients' perceptions on the options have rarely been addressed. Methods: A cross-sectional survey was conducted on 50 patients with PTMC who were under either active surveillance (n = 20) or postoperative follow-up (n = 30). The primary outcome was anxiety, which was measured using the State-Trait Anxiety Inventory (STAI). A questionnaire that comprised six items about PTMCrelated symptoms and concerns, which were measured with a visual analog scale, was also administered. Cohen's d effect size was calculated to express group differences. Multiple regression analysis was used to examine the relationships between state anxiety and other variables. Results: The median age and observation period were 61.5 years (range, 40-83 years) and 4.1 years (range, 0-8.6 years), respectively. The female/male ratio was 38/12. Compared with the surgery group, the active surveillance group showed higher scores in both state anxiety and trait anxiety, with corresponding effect sizes of 0.55 (confidence interval [CI]-0.03 to 1.1; p = 0.068) and 0.63 (CI 0.02-1.2; p = 0.037), respectively. Trait anxiety (b = 0.83) and observation time (b =-1.57) were the significant predictors of state anxiety. Moderate effect sizes were observed for ''discomfort in the neck'' (-0.53; CI-1.11 to 0.04); ''weak voice'' (-0.46; CI-1.03 to 0.12); and ''nervous about neck appearance'' (-0.64; CI-1.23 to-0.07), in favor of active surveillance. Conclusions: State anxiety among patients with PTMC seemed to be a reflection of an individual's trait rather than management. Understanding the patients' view appears to be key to improve shared decision-making.

Thermal Ablation for Papillary Thyroid Microcarcinoma: How Far We Have Come?

“… 6 Moreover, once the PTMC was diagnosed, part of these patients was in various degrees of anxiety and upset about the tumor-carrying state. 4 , 25 , 26 Thus, some patients are more willing to accept relatively aggressive interventions instead of AS. Therefore, various TA approaches currently are being introduced into clinical practice as the alternatives for patients with low-risk PTMC.…”

“…However, one important problem during the AS that may easily be overlooked is the psychological uncertainty and anxiety could be stronger than immediate active interventions. 4 , 66 , 67 Moreover, in the 2016 Chinese expert consensus 8 on this topic, the recommendation of close observation for low-risk PTMC patients was still controversial and had a more stringent criterion. Consequently, it seems that TA might be a good solution to compensate for image deriving PTMC overdiagnosis.…”

“…In addition, papillary thyroid microcarcinoma (PTMC), defined as the papillary thyroid carcinoma (PTC) with a diameter maximum of 10 mm, accounts for a considerable proportion of the DTC which should also be paid enough attention. [4][5][6][7] To date, thyroid lobectomy and selective central lymph nodule dissection (SCLND) are the predominant treatment for PTMC in China, even though many of these tumor cells never grow, or grow very slowly during the long-term follow-up. 8 Although great therapeutic progress in the surgery modalities for DTC has been achieved in the last decades, from traditional open thyroidectomy to endoscopic thyroidectomy, the complications subsequent to surgery were still observed in recent literature.…”

“…8 Although great therapeutic progress in the surgery modalities for DTC has been achieved in the last decades, from traditional open thyroidectomy to endoscopic thyroidectomy, the complications subsequent to surgery were still observed in recent literature. 5,9 Therefore, with the growing concerns for the over-detection rate and overtreatment of PTMC, a range of works have tried to explore alternatives for better treatment modalities, including but not limited to active surveillance (AS) 4,10,11 and thermal ablation (TA). 12,13 Currently, TA technologies, as one of novel, potentially more acceptable methods with the same treatment effect, have emerged as an interesting candidate which may increase the patients' experience and compliance.…”

Active surveillance in low risk papillary thyroid carcinoma

“…Conversely, “maximalist” patients chose the immediate surgical option as the only possible alternative, expressing a rush to undergo intervention. These individuals perceived PMC as a life-threatening disease that could be cured by surgery, and expressed anxiety about the development of local and/or distant metastases during follow-up[ 69 , 70 ]. These causes were reported to be the main sources of worry in recent research, which described the experiences of patients with low-risk PMCs under an AS program[ 71 ].…”