Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for Low-risk Thyroid Cancer

• Published in: Annals of surgery Vol. 282; no. 2; p. 275
• Main Authors: Antunez, Alexis G, Sinco, Brandy R, Saucke, Megan C, Bushaw, Kyle J, Jensen, Catherine B, Dream, Sophie, Fingeret, Abbey L, Livhits, Masha J, Mathur, Aarti, McDow, Alexandria, Roman, Sanziana A, Voils, Corrine I, Sydnor, Justin, Pitt, Susan C
• Format: Journal Article
• Language: English
• Published: United States 01.08.2025
• Subjects: Adult; Aged; Choice Behavior; Female; Humans; Longitudinal Studies; Male; Middle Aged; Patient Preference; Prospective Studies; Thyroid Neoplasms - psychology; Thyroid Neoplasms - surgery; Thyroidectomy - methods; Thyroidectomy - psychology; Treatment Outcome; thyroid cancer; constant sum scale; decision-making; outcomes
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000006347

To evaluate the relative importance of treatment outcomes to patients with low-risk thyroid cancer (TC). Overuse of total thyroidectomy (TT) for low-risk TC is common. Emotions from a cancer diagnosis may lead patients to choose TT, resulting in outcomes that do not align with their preferences. Adults with clinically low-risk TC enrolled in a prospective, multi-institutional, longitudinal cohort study from November 2019 to June 2021. Participants rated treatment outcomes at the time of their surgical decision and again 9 months later by allocating 100 points among 10 outcomes. t tests and Hotelling T 2 statistic compared outcome valuation within and between subjects based on chosen extent of surgery (TT vs lobectomy). Of 177 eligible patients, 125 participated (70.6% response) and 114 completed the 9-month follow-up (91.2% retention). At the time of the treatment decision, patients choosing TT valued the risk of recurrence more than those choosing lobectomy and the need to take thyroid hormone less ( P <0.05). At repeat valuation, all patients assigned fewer points to cancer being removed and the impact of treatment on their voice and more points to energy levels ( P <0.05). The importance of the risk of recurrence increased for those who chose lobectomy and decreased for those choosing TT ( P <0.05). The relative importance of treatment outcomes changes for patients with low-risk TC once the outcome has been experienced to favor quality of life over emotion-related outcomes. Surgeons can use this information to discuss the potential for asthenia or changes in energy levels associated with total thyroidectomy.