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October 18, 2019
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Patient preference for maximal thyroid cancer surveillance linked to increased use of resources

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Patients with thyroid cancer who opt for maximal vs. minimal surveillance after being declared disease-free consume a greater amount of health care resources without clear evidence of improved outcomes, according to results of a retrospective study published in Cancer.

Physicians should consider the influence of patient preferences on use of medical resources when discussing surveillance of low-risk thyroid cancer, researchers noted.

“There’s a tendency to think of cancer as this big bad thing that we just need to throw everything we have in our arsenal at,” Joshua Evron, MD, assistant professor of medicine at The University of North Carolina at Chapel Hill, said in a press release. “That’s not necessarily the case. In certain contexts, like these, less may indeed be more. In their discussions, doctors may be able to better help patients understand the potential benefits of a less intensive approach.”

The cost of cancer care in the United States has risen substantially in the past 3 decades, with spending projected to exceed $150 billion by 2020. Incidence of thyroid cancer also has increased, and diagnosis and management of low-risk disease has contributed to the rise in health care costs. This includes increasing use of imaging during postoperative surveillance, which in most scenarios confers no clear survival benefit, according to the researchers. More intensive surveillance also poses risks for patients, including the potential for false-positives and unnecessary treatment intensification or additional surgery, researchers noted.

Evron and colleagues evaluated the impact of patient preferences on surveillance intensity among 2,183 adults (median age, 50 years; range, 18-79; 78.3% women) diagnosed with thyroid cancer in 2014 and 2015 and declared disease-free after treatment.

The researchers gathered patient information from the Georgia and Los Angeles County SEER registries. They linked the data to patient reports on health care use during the past year and responses to the Medical Maximizer-Minimizer Scale, which gauged patients’ general health care preferences.

Among all patients, 31.6% were considered minimizers — meaning they preferred to see a physician as little as possible — 42.5% were deemed moderate maximizers and 25.9% were classified as strong maximizers, meaning they preferred to treat the cancer as vigorously as possible regardless of whether it would have a major impact on overall outcomes.

Results showed 38.5% of strong maximizers, 27.3% of moderate maximizers and 25.2% of minimizers had four or more visits to a physician in the year prior to being surveyed. Additionally, 29.5% of strong maximizers, 24.9% of moderate maximizers and 18.3% of minimizers had two or more neck ultrasounds.

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Researchers performed ordered logistic regression analyses with cumulative logit for physician visits, neck ultrasounds, radioactive iodine scans and other imaging, and controlled for age, sex, race, ethnicity, comorbidity, disease stage and SEER site.

In these analyses, strong maximizers appeared significantly more likely than minimizers to report four or more physician visits (OR = 1.45; 95% CI, 1.1-1.92), two or more neck ultrasounds (OR = 1.58; 95% CI, 1.17-2.14), at least one radioactive iodine scan (OR = 1.73; 95% CI, 1.19-2.5) and at least one additional imaging study (OR = 2.06; 95% CI, 1.56-2.72).

Patient self-reporting, as well as a limited sample size, served as the study’s primary limitations.

Megan Haymart, MD
Megan Haymart

“Our findings demonstrate that patients with a preference for maximal medical care did, indeed, tend to receive more follow-up care, including a greater number of doctor visits and imaging tests,” Megan Haymart, MD, endocrinologist at Michigan Medicine and member of the Institute for Healthcare Policy & Innovation at University of Michigan, said in a press release. “These results help to explain why we see significant differences in the management of low-risk thyroid cancer that isn’t explained by disease-related factors.” – by John DeRosier

Disclosures: The study authors report no relevant financial disclosures.