Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;27(1):1-7.
doi: 10.1016/j.eprac.2020.11.003. Epub 2020 Nov 17.

NATIONAL SURVEY OF ENDOCRINOLOGISTS AND SURGEONS REGARDING ACTIVE SURVEILLANCE FOR LOW-RISK PAPILLARY THYROID CANCER

Benjamin R Roman  1 , Juan P Brito  2 , Megan C Saucke  3 , Shivangi Lohia  4 , Catherine B Jensen  3 , Nick Zaborek  3 , Jamia Linn Jennings  5 , Robert M Tuttle  4 , Louise Davies  6 , Susan C Pitt  3
Affiliations

NATIONAL SURVEY OF ENDOCRINOLOGISTS AND SURGEONS REGARDING ACTIVE SURVEILLANCE FOR LOW-RISK PAPILLARY THYROID CANCER

Benjamin R Roman et al. Endocr Pract. 2021 Jan.

Abstract

Objective: Active surveillance for low-risk papillary thyroid cancer (PTC) was endorsed by the American Thyroid Association guidelines in 2015. The attitudes and beliefs of physicians treating thyroid cancer regarding the active surveillance approach are not known.

Methods: A national survey of endocrinologists and surgeons treating thyroid cancer was conducted from August to September 2017 via professional society emails. This mixed-methods analysis reported attitudes toward potential factors impacting decision-making regarding active surveillance, beliefs about barriers and facilitators of its use, and reasons why physicians would pick a given management strategy for themselves if they were diagnosed with a low-risk PTC. Survey items about attitudes and beliefs were derived from the Cabana model of barriers to guideline adherence and theoretical domains framework of behavior change.

Results: Among 345 respondents, 324 (94%) agreed that active surveillance was appropriate for at least some patients, 81% agreed that active surveillance was at least somewhat underused, and 76% said that they would choose surgery for themselves if diagnosed with a PTC of ≤1 cm. Majority of the respondents believed that the guidelines supporting active surveillance were too vague and that the current supporting evidence was too weak. Malpractice and financial concerns were identified as additional barriers to offering active surveillance. The respondents endorsed improved information resources and evidence as possible facilitators to offering active surveillance.

Conclusion: Although there is general support among physicians who treat low-risk PTC for the active surveillance approach, there is reluctance to offer it because of the lack of robust evidence, guidelines, and protocols.

Keywords: active surveillance; low-risk; microcarcinoma; papillary; survey; thyroid cancer.

PubMed Disclaimer

Conflict of interest statement

Disclosure

The authors have no multiplicity of interest to disclose.

Figures

<b>Fig. 1</b>.
Fig. 1.
Physicians’ level of experience with active surveillance (AS).
Fig. 2.
Fig. 2.
Physicians’ beliefs about the level of use of different approaches to the management of low-risk papillary thyroid cancer measuring ≤1 cm (microcarcinomas). RAI = radioactive iodine.
<b>Fig. 3</b>.
Fig. 3.
Physicians’ beliefs about utilization, data, and guidelines related to active surveillance (AS).
See this image and copyright information in PMC

References

    1. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1–e33. - PMC - PubMed
    1. Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13(4): 381–387. - PubMed
    1. Ito Y, Miyauchi A, Inoue H, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg. 2010;34(1):28–35. - PubMed
    1. Sugitani I, Toda K, Yamada K, Yamamoto N, Ikenaga M, Fujimoto Y. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg. 2010;34(6): 1222–1231. - PubMed
    1. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34. - PMC - PubMed