Physician management of thyroid cancer patients' worry

Abstract

Purpose: The purpose of this study is to understand physician management of thyroid cancer-related worry.

Methods: Endocrinologists, general surgeons, and otolaryngologists identified by Surveillance, Epidemiology, and End Results (SEER) patients were surveyed 2018-2019 (response rate 69% (448/654)) and asked to rate in general their patients' worry at diagnosis and actions they take for worried patients. Multivariable-weighted logistic regressions were conducted to determine physician characteristics associated with reporting thyroid cancer as "good cancer" and with encouraging patients to seek help managing worry outside the physician-patient relationship.

Results: Physicians reported their patients as quite/very worried (65%), somewhat worried (27%), and a little/not worried (8%) at diagnosis. Half of the physicians tell patients their thyroid cancer is a "good cancer." Otolaryngology (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.08-3.21, versus endocrinology), private practice (OR 2.48, 95% CI 1.32-4.68, versus academic setting), and Los Angeles (OR 2.24, 95% CI 1.45-3.46, versus Georgia) were associated with using "good cancer." If patients are worried, 97% of physicians make themselves available for discussion, 44% refer to educational websites, 18% encourage communication with family/friends, 13% refer to support groups, and 7% refer to counselors. Physicians who perceived patients being quite/very worried were less likely to use "good cancer" (OR 0.54, 95% CI 0.35-0.84) and more likely to encourage patients to seek help outside the physician-patient relationship (OR 1.82, 95% CI 1.17-2.82).

Implications for cancer survivors: Physicians perceive patient worry as common and address it with various approaches, with some approaches of unclear benefit. Efforts are needed to develop tailored interventions targeting survivors' psychosocial needs.

Keywords: Good cancer; Oncology; Population-based; Survey; Thyroid cancer; Worry.

Figure 1.

Physician reported actions to manage patient worry. Respondents were asked to select all actions they take if their patients are worried.

Figure 2a.

Physician report on the role of patient worry in increasing aspects of healthcare utilization. Responses were based on a 5-point Likert scale as follows: never, rarely, sometimes, often, a lot.

Figure 2b.

Physician report on the role of patient worry in increasing treatment intensity. Responses were based on a 5-point Likert scale as follows: never, rarely, sometimes, often, a lot.