Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
University of Michigan Medical School, Ann Arbor.
JAMA Otolaryngol Head Neck Surg. 2022 Jan 1;148(1):43-51. doi: 10.1001/jamaoto.2021.2824.
Surveillance imaging and visits are costly and have not been shown to improve oncologic outcomes for patients with head and neck cancer (HNC). However, the benefit of surveillance visits may extend beyond recurrence detection. To better understand surveillance and potentially develop protocols to tailor current surveillance paradigms, it is important to elicit the perspectives of the clinicians who care for patients with HNC.
To characterize current surveillance practices and explore clinician attitudes and beliefs on deintensifying surveillance for patients with HNC.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was performed from January to March 2021. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from March to April 2021. Otolaryngologists and radiation oncologists were recruited using purposive and snowball sampling strategies.
The main outcomes were current practice, attitudes, and beliefs about deintensifying surveillance and survivorship as well as patients' values and perspectives collected from interviews of participating physicians.
Twenty-one physicians (17 [81%] men) were interviewed, including 13 otolaryngologists and 8 radiation oncologists with a median of 8 years (IQR, 5-20 years) in practice. Twelve participants (57%) stated their practice comprised more than 75% of patients with HNC. Participants expressed that there was substantial variation in the interpretation of the surveillance guidelines. Participants were open to the potential for deintensification of surveillance or incorporating symptom-based surveillance protocols but had concerns that deintensification may increase patient anxiety and shift some of the burden of recurrence monitoring to patients. Patient and physician peace of mind, the importance of maintaining the patient-physician relationship, and the need for adequate survivorship and management of treatment-associated toxic effects were reported to be important barriers to deintensifying surveillance.
In this qualitative study, clinicians revealed a willingness to consider altering cancer surveillance but expressed a need to maintain patient and clinician peace of mind, maintain the patient-clinician relationship, and ensure adequate monitoring of treatment-associated toxic effects and other survivorship concerns. These findings may be useful in future research on the management of posttreatment surveillance.
监测成像和就诊既昂贵又不能改善头颈部癌症（HNC）患者的肿瘤学结局。然而，监测就诊的益处可能超出复发检测。为了更好地了解监测并可能制定适合当前监测模式的方案，了解照顾 HNC 患者的临床医生的观点很重要。
描述当前的监测实践，并探讨临床医生对减少 HNC 患者监测强度的态度和信念。
设计、地点和参与者：这项定性研究于 2021 年 1 月至 3 月进行。采用解释性描述方法，对访谈进行分析以产生主题描述。数据分析于 2021 年 3 月至 4 月进行。耳鼻喉科医生和放射肿瘤学家通过有针对性和滚雪球抽样策略招募。
主要结果是从参与医生的访谈中收集的当前实践、对减少监测和生存的态度和信念，以及患者的价值观和观点。
对 21 名医生（17 名[81%]为男性）进行了采访，其中包括 13 名耳鼻喉科医生和 8 名放射肿瘤学家，中位数为 8 年（IQR，5-20 年）。12 名参与者（57%）表示他们的实践包括超过 75%的 HNC 患者。参与者表示，对监测指南的解释存在很大差异。参与者对监测或纳入基于症状的监测方案的潜在可能性持开放态度，但担心减少监测可能会增加患者的焦虑，并将一些复发监测的负担转移给患者。患者和医生的安心、维持医患关系的重要性以及需要充分的生存和治疗相关毒性管理被报告为减少监测的重要障碍。
在这项定性研究中，临床医生表示愿意考虑改变癌症监测，但表示需要保持患者和临床医生的安心，维持医患关系，并确保充分监测与治疗相关的毒性作用和其他生存问题。这些发现可能对未来关于治疗后监测管理的研究有用。
