Receipt of Radioactive Iodine Treatment for Differentiated Thyroid Cancer and Perception of Patient Choice
In a study reported in the Journal of Clinical Oncology, Wallner et al found that many patients with differentiated thyroid cancer reported feeling they had no choice in receipt of radioactive iodine treatment.
As stated by the investigators, “For many patients with differentiated thyroid cancer, use of … radioactive iodine does not improve survival or reduce recurrence risk. Yet, there is wide variation in of radioactive iodine use, emphasizing the importance of understanding patient perspectives regarding of radioactive iodine decision-making.”
Study Details
The study included survey of all eligible patients diagnosed with thyroid cancer from 2014 to 2015 from the Georgia and Los Angeles SEER (Surveillance, Epidemiology, and End Results) registries (n = 2,632, response rate = 63%). Data from 1,319 patients for whom selective of radioactive iodine use was recommended were included in the analysis. A five-point Likert-like scale was used to measured how strongly patients felt their physician recommended treatment with radioactive iodine (recommended, not for or against, or against) and how satisfied patients were with their decision to receive radioactive iodine (more satisfied = score ≥ four).
Perception of Choice
Overall, 75.9% of patients received radioactive iodine, with 55.8% reporting feeling they did not have a choice in their receipt of radioactive iodine. The likelihood of perceiving no choice about their receipt of radioactive iodine treatment was greater among patients with physicians who more strongly recommended radioactive iodine (adjusted odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.13–2.17). Patients who felt they did not have a choice regarding radioactive iodine treatment were more likely to receive radioactive iodine (adjusted OR = 2.50, 95% CI = 1.64–3.82). Overall, 84.9% of patients who perceived they did not have a choice received radioactive iodine, vs 68.3% of patients who felt they did have a choice. Patients who felt they did not have a choice regarding radioactive iodine treatment were more likely to report lower decision satisfaction (adjusted OR = 2.31, 95% CI = 1.67–3.20).
The investigators concluded: “Many patients did not feel they had a choice about whether to receive radioactive iodine. Patients who perceived they did not have a choice were more likely to receive radioactive iodine and report lower decision satisfaction, suggesting a need for more shared decision-making to reduce overtreatment.”
Megan R. Haymart, MD, of the Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan Health System, Ann Arbor, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by a National Cancer Institute grant. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
