Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Ann Surg. 2022 Jul 1;276(1):e40-e47. doi: 10.1097/SLA.0000000000004417. Epub 2020 Oct 16.
The aim of this study was to determine physician-reported use of and barriers to active surveillance for thyroid cancer.
It is not clear whether active surveillance for thyroid cancer is widely used.
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 and 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 to 19 years [odds ratio, OR 0.50 [95% confidence interval, CI 0.28-0.92]; 20 to 29 years [OR 0.31 (95% CI 0.15-0.62)]; >30 years [OR 0.30 (95% CI 0.15-0.61)] and higher patient volume 11 to 30 patients per year [OR 0.39 (95% CI 0.21 -0.70)] and >50 patients per year [OR 0.33 (95% CI 0.16-0.71)] compared to < 10, with no significant difference in those seeing 31 to 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%).
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.
本研究旨在确定医生报告的甲状腺癌主动监测的使用情况和障碍。
目前尚不清楚是否广泛使用甲状腺癌主动监测。
通过对佐治亚州和洛杉矶县监测、流行病学和最终结果（SEER）登记处的甲状腺癌患者进行调查，鉴定外科医生和内分泌学家。进行多变量加权逻辑回归分析，以确定医生对主动监测的接受程度和使用情况。结果：在确定的 654 名合格医生中，有 448 名医生对调查做出了回应（回应率为 69%）。大多数（76%）医生认为主动监测是一种合适的管理选择，但只有 44%的医生在其实践中使用它。表示主动监测是合适的管理方法但未报告使用的医生的特征包括：行医年限较长（参考组为 10 年以下行医年限）：10 至 19 年[比值比（OR）0.50（95%置信区间（CI）0.28-0.92）]；20 至 29 年[OR 0.31（95%CI 0.15-0.62）]；>30 年[OR 0.30（95%CI 0.15-0.61）]和更高的患者数量（每年 11 至 30 名患者[OR 0.39（95%CI 0.21-0.70）]和每年>50 名患者[OR 0.33（95%CI 0.16-0.71）]，而每年 31 至 50 名患者的差异不显著。医生报告了实施主动监测的多个障碍，包括患者不希望（80.3%）、担心失访（78.4%）、更多的患者担忧（57.6%）和担心医疗事故诉讼（50.9%）。
尽管大多数医生认为主动监测是合适的管理方法，但超过一半的医生并未使用它。解决现有障碍是提高接受度的关键。
