Thyroid Cancer and Radiofrequency Ablation 101: Why Active Surveillance AS is Not an the most attractive alternative to Surgery to US cancer patients.
1. Efforts to increase AS adoption in the U.S. should focus on improving provider awareness, knowledge, and interest.
2. The problems with AS is the patient willing to allow a thyroid cancer no matter how small and low risk to stay in their neck for years with a 10% chance they will need surgery later.
3. Telling them that the late surgery is a safe as the original surgery dose not make them less nervous or less anxiety ridden.
4. Telling the patient they only have two options (surgery or AS).
5. Using a RF ablation technique that can be verified by cutting needle biopsy post treatment is a third option that many would gladly take instead of surgery or long term with the cancer in their neck.
6. The size of micropapillary thyroid cancers treated with AS is small <1.2 cm.
7. The same criteria of no invasion or lymph nodes as in AS can be used to determine if RF is indicated.Also however there needs to be clear location criteria. No location near the thyroid capsule.
8. A well know expert thyroid surgeon at a major University has suggested that with thyroid RF for micro-papillary cancers that fit the criteria will replace AS in most cases when they don’t want surgery and are nervous and anxious carrying the cancer in their neck for years.
9. Thyroid RF for micro-papillary thyroid cancer is available now to those that are interested.
10. Several centers in the US, Europe and Asia are offering it in patients that refuse both surgery and AS.
11. Call me for details for micro-papillary cancer Thyroid ablation with radiofrequency in my center. 310-393-8860 or email to firstname.lastname@example.org.
12. ATA meeting 2019 Abstract below describes the mixed feeling about AS in the medical comunity.
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Thyroid Cancer Saturday Poster Clinical
ADOPTION OF ACTIVE SURVEILLANCE: ANALYSIS OF A LARGE NATIONAL COHORT OF PHYSICIANS
N. Yang1, M.C. Saucke1, N. Marka1, B. Hanlon1, A.D. McDow2, K.L. Long1, S.C. Pitt1
1Department of Surgery, University of Wisconsin, Madison, WI; 2Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
Adoption of active surveillance (AS) for papillary thyroid cancer (PTC) is in the early stages in the U.S. We aimed to characterize AS adoption nationally. We mailed a random sample of 1,500 providers in the American Medical Association a survey with 2 cases scenarios: 1) a 45yo female with a solitary, node‐negative 0.8cm PTC and no adverse features or history and 2) the same case but the patient preferred AS. We compared “non‐adopters” (who did not recommend AS) to “adopters” who recommended AS at least once using Fisher’s exact and t‐tests. Of 488 responses (32.5%), 464 treated PTC and were analyzed (144 endocrinologists, 122 general surgeons, and 198 otolaryngologists). Respondents were 53.6 ± 9 yo and practiced 20.7 ± 9 yrs; 78.2% (n = 347) were male; 76.1% (n = 334) White. Non‐adopters (45.7%; n = 212) were significantly less likely than adopters to be in academics (17.2% vs 29.5%), see >25 PTC patients/yr (24.4% vs 42.2%), be aware AS is an option (79.8% vs 94.8%), or use ATA guidelines (80.0% vs 87.8%). Non‐adopters were also less likely to know if a patient is appropriate for AS (29.2% vs 49.8%), have resources to perform AS (46.2% vs 63.7%), want to increase AS use (6.5% vs 19.8%), believe AS is underused (66.7% vs 84.5%), or feel colleagues offer AS (1.1% vs 5.1%). Non‐adopters were more likely to have reservations about AS (37.5% vs 10.4%), agree AS makes them anxious (30.1% vs 7.6%), be concerned patients may have a poor outcome (34.9% vs 12.0%), and feel AS is a psychological burden for patients (48.1% vs 34.0%). We also compared “partial adopters” who only recommended AS if the patient preferred AS (42.2%; n = 196) to “full adopters” who recommended AS for both cases (11.4%; n = 53). Partial adopters were less likely to discuss AS in their practice (82.5% vs 94.3%) and more likely to have reservations about AS (12.9% vs 1.9%), be anxious about AS (9.3% vs 1.9%), and believe AS psychologically burdens patients (38.3% vs 18.9%). P < 0.05 for all comparisons. Efforts to increase AS adoption in the U.S. should focus on improving provider awareness, knowledge, and interest. Further evaluation of AS outcomes is needed to minimize provider uncertainty and should assess the psychological impact of AS on patients.