Patient and surgeon perspectives on the American Thyroid Association
(ATA) 2015 & British Thyroid Association (BTA) 2014 guidelines in the
management of “Low-Risk” Thyroid Cancers (LRDTCs): Two sides of the
coin
Abstract
Objectives: To investigate how surgeons interpret the ATA 2015 and BTA
2014 guidelines for low risk well differentiated thyroid cancers
(LRDTCs) and how they impact patient experiences across the UK. Design:
Three nationally disseminated anonymised questionnaires. Setting: A
nationwide snapshot of LRDTC management. Participants: Thyroid surgeons
and their respective thyroid cancer multidisciplinary teams (MDTs) and
thyroid cancer patients. Main outcome measures: The outcomes of interest
were how surgeons/MDTs are managing LRDTCs and patient perspectives on
‘shared-decision-making’ and their ideal surgical management for LRDTCs.
Results: 74 surgeons responded. 88% utilised BTA guidelines to assess
recurrence risk. Tumour size, histology, stage T3b and central nodal
involvement were important for >85%, but age
(>45 years) only for 50%. In T1 (2cm), Thy5 solitary
nodule, 58% supported hemi-thyroidectomy (HT), with 33% for total
thyroidectomy (TT). In T2 (3cm) PTC, 54% opted for TT, with 24%
favouring HT. Over 90% recommended TT for any incidentally excised
microscopically positive lymph nodes. In T1a(m) multifocal micro-PTC,
63% suggested HT, but with contralateral benign nodules, 66% supported
TT. 40% of patients felt ‘pros and cons’ of different managements were
not fully explained. 47% felt they didn’t have significant input in
their management, with 53% feeling final management was clinician’s
choice. 60% preferred TT, with 80% wanting to ensure there was no
cancer left and avoid recurrence. 20% preferred HT, with 46% wishing
to avoid lifelong thyroxine. Conclusions: There is variation in risk
assessment and management of LRDTCs nationally, with contrasting views
of optimum treatment between patients and clinicians. These variations
in practice are affecting patient experiences nationally.