Barriers to the use of active surveillance for thyroid cancer: Results of a physician survey

Details

• Alternative Title:
  Ann Surg
• Personal Author:
  Hughes, David T. ; Reyes-Gastelum, David ; Ward, Kevin C. ; Hamilton, Ann S. ; Haymart, Megan R.
• Description:
  Objective:
  
  To determine physician-reported use of and barriers to active surveillance for thyroid cancer.
  
  Summary Background Data:
  
  It isn’t clear if active surveillance for thyroid cancer is widely used.
  
  Methods:
  
  Surgeons and endocrinologists identified by thyroid cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County were surveyed between 2018–2019. Multivariable weighted logistic regression analyses were conducted to determine physician acceptance and use of active surveillance.
  
  Results:
  
  Of the 654 eligible physicians identified, 448 responded to the survey (69% response rate). The majority (76%) believed that active surveillance was an appropriate management option, but only 44% used it in their practice. Characteristics of physicians who stated that active surveillance was appropriate management, but did not report using it included more years in practice (reference group < 10 years in practice): 10–19 years - OR 0.50 [CI 0.28–0.92]; 20–29 years - OR 0.31 [CI 0.15–0.62]; ≥30 years - OR 0.30 [CI 0.15–0.61] and higher patient volume 11–30 patients per year (OR 0.39 [CI 0.21–0.70]) and >50 patients per year (OR 0.33 [CI 0.16–0.71]) compared to ≤ 10, with no significant difference in those seeing 31–50 patients. Physicians reported multiple barriers to implementing active surveillance including patient does not want (80.3%), loss to follow-up concern (78.4%), more patient worry (57.6%) and malpractice lawsuit concern (50.9%).
  
  Conclusion and Relevance:
  
  Despite most physicians considering active surveillance to be appropriate management, more than half are not using it. Addressing existing barriers is key to improving uptake.
  
  
• Subjects:
  Humans SEER Program Surgeons Surveys And Questionnaires Thyroid Neoplasms Watchful Waiting
• Keywords:
  Buprenorphine Methadone Mortality Naltrexone Treatment
• Source:
  Ann Surg. 276(1):e40-e47
• Pubmed ID:
  33074908
• Pubmed Central ID:
  PMC8549720
• Document Type:
  Journal Article
• Funding:
  HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; R01 HS024512/HS/AHRQ HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; R01 CA201198/CA/NCI NIH HHSUnited States/ ; HHSN261201800003C/CA/NCI NIH HHSUnited States/
• Volume:
  276
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:326ca3ac90568c91ab611091ef66f8dc13da6f0f9171af86934c251824295dd039079e9dac1cd706d73c203b54665143e7194d7ae18faa4b6313cbe51c7c03e8
• Download URL:
  https://stacks.cdc.gov/view/cdc/111126/cdc_111126_DS1.pdf
• File Type:
  [PDF - 689.36 KB ]