Kim Min Joo, Moon Jae Hoon, Lee Eun Kyung, Song Young Shin, Jung Kyong Yeun, Lee Ji Ye, Kim Ji-Hoon, Lim Woojin, Kim Kyungsik, Park Sue K, Park Young Joo
Eur Thyroid J. 2025 Jan 9;14(1). doi: 10.1530/ETJ-24-0281. Print 2025 Feb 1.
Active surveillance (AS) has emerged as a viable alternative to immediate surgery for low-risk thyroid cancer. However, several barriers still hinder its widespread adoption and implementation by physicians.
In 2024, an email survey was conducted among members of the Korea Thyroid Association to assess their perspectives on AS. The survey comprised questions about clinical case scenarios, perceptions of the benefits and risks associated with AS, factors influencing the consideration of AS and unmet needs for the implementation of AS.
Among the 287 physicians surveyed, 40.8% were endocrinologists, followed by general surgeons at 20.9% and otolaryngologists at 19.9%. The majority worked in tertiary hospitals and had over 10 years of experience. Regarding a 65-year-old man with a 0.7 cm low-risk thyroid cancer, 74.6% of the respondents considered AS. Endocrinologists and physicians with higher self-assessment and experience explaining AS to patients were more inclined to consider AS. Although the respondents recognized the benefits of AS, such as avoiding surgery and reducing surgical complications, they expressed concerns about potential risks, including the possibility of patient lawsuits due to disease progression and patient worry and anxiety about the disease. Challenges in screening candidates for AS were highlighted, especially in detecting recurrent laryngeal nerve involvement and lymph node metastases. Additionally, physicians noted unmet needs in AS implementation, specifically regarding psychological support for patients and reimbursement for long-term follow-up costs.
The survey underscored the need for further research and initiatives to overcome the barriers and implement AS for the management of low-risk thyroid cancer.
主动监测（AS）已成为低风险甲状腺癌立即手术的一种可行替代方案。然而，仍有几个障碍阻碍医生广泛采用和实施该方案。
2024年，对韩国甲状腺协会成员进行了一项电子邮件调查，以评估他们对主动监测的看法。该调查包括有关临床病例场景、对主动监测相关益处和风险的认知、影响考虑主动监测的因素以及主动监测实施中未满足的需求等问题。
在接受调查的287名医生中，40.8%是内分泌科医生，其次是普通外科医生，占20.9%，耳鼻喉科医生占19.9%。大多数人在三级医院工作，并有超过10年的经验。对于一名患有0.7厘米低风险甲状腺癌的65岁男性，74.6%的受访者考虑采用主动监测。内分泌科医生以及自我评估较高且有向患者解释主动监测经验的医生更倾向于考虑采用主动监测。尽管受访者认识到主动监测的益处，如避免手术和减少手术并发症，但他们也表达了对潜在风险的担忧，包括因疾病进展导致患者诉讼的可能性以及患者对疾病的担忧和焦虑。突出了筛选主动监测候选者的挑战，特别是在检测喉返神经受累和淋巴结转移方面。此外，医生指出了主动监测实施中未满足的需求，特别是在患者心理支持和长期随访费用报销方面。
该调查强调需要进一步研究和采取举措，以克服障碍并实施主动监测来管理低风险甲状腺癌。
