Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Division of Surgery Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Clin Endocrinol Metab. 2021 Mar 25;106(4):e1728-e1737. doi: 10.1210/clinem/dgaa942.
Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States.
This work aimed to understand factors associated with the adoption of AS.
We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases).
The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (P < .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (P = .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (P = .03) and more likely to be anxious (P = .04), have reservations (P = .03), and have concerns about the psychological burden (P = .009) of AS. Few respondents (3.2%) believed patients were aware of AS.
Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.
在美国，甲状腺癌的主动监测（AS）结合连续超声检查是一种较新的管理选择。
本研究旨在了解与 AS 采用相关的因素。
我们调查了美国医学协会大师档案中的内分泌学家和外科医生。为了估计采用率，受访者为 2 个适合 AS 的假设病例推荐治疗方案。既定的指南实施模型指导问卷的开发。主要结果包括 AS 的采用（不采用者与采用者，分别是未推荐或至少推荐一次 AS；部分采用者与完全采用者，分别是推荐 AS 用于一个或两个病例）。
464 名受访者（33.3%的回复率）在人口统计学上代表了治疗甲状腺癌的专业。不采用者（45.7%）与采用者相比，在学术环境中执业的可能性明显较低（P < 0.001），每年看 25 例以上甲状腺癌患者，对 AS 有了解，使用适用的指南（P = 0.04），了解如何确定患者是否适合 AS，有资源进行 AS，或有动机使用 AS。不采用者也明显更有可能对 AS 感到焦虑或有所保留，担心不良结局，或认为 AS 会给患者带来心理负担。在采用者中，部分采用者和完全采用者相似，但部分采用者与患者讨论 AS 的可能性较小（P = 0.03），更有可能感到焦虑（P = 0.04）、有所保留（P = 0.03），对 AS 的心理负担也更为担心（P = 0.009）。很少有受访者（3.2%）认为患者了解 AS。
广泛采用 AS 将需要提高患者和医生的意识、兴趣，并评估结果。
