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Effect of Patient General Preference for More vs Less Medical Care on Intensity of Posttreatment Thyroid Cancer Surveillance


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In an analysis reported in the Journal of Clinical Oncology, Evron et al found that patients with thyroid cancer who were declared disease-free after initial treatment were more likely to have increased numbers of physician visits and imaging tests if they reported a generalized preference for greater vs less medical care on the Medical Maximizer-Minimizer Scale.

“Because increased surveillance does not clearly correlate with improved outcomes, poses potential risks to patients, and contributes to increased health-care costs, stronger consideration of the role of patient preferences is necessary when framing discussions on surveillance.”
— Evron et al

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The study involved patients diagnosed with thyroid cancer between January 2014 and December 2015 from the Georgia and Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registries. A total of 2,183 patients who were declared disease-free (response rate = 63%) after initial treatment answered questionnaires on health-care utilization during the past year and provided responses to the Medical Maximizer-Minimizer Scale, with responses being linked to the SEER data.

Resource Use by Maximizer-Minimizer Category

Among the 2,183 disease-free patients, 31.6% were classified as minimizers, 42.5% as moderate maximizers, and 25.9% as strong maximizers. In the prior year, 25.2%, 27.3%, and 38.5% of minimizers, moderate maximizers, and strong maximizers, respectively, had four or more doctor visits, and 18.3%, 24.9%, and 29.5%, respectively, received two or more neck ultrasounds.

In analysis controlling for age, sex, race/ethnicity, comorbidity, stage, and SEER site, strong maximizers were significantly more likely vs minimizers to report more than four doctor visits (odds ratio [OR] = 1.45, 95% confidence interval [CI] =1.10–1.92), more than two neck ultrasounds (OR = 1.58, 95% CI = 1.17–2.14), one or more radioactive iodine scan (OR = 1.73, 95% CI = 1.19–2.50), and one or more additional imaging study (OR = 2.06, 95% CI = 1.56–2.72).

Moderate maximizers were not significantly more likely vs minimizers to have four or more doctor visits or one or more radioactive iodine scan, but were significantly more likely to have two or more neck ultrasounds (OR = 1.40, 95% CI = 1.08–1.81) and one or more additional imaging test (OR = 1.31, 95% CI = 1.04–1.65).

KEY POINTS

  • Strong maximizers were more likely vs minimizers to report four or more doctor visits, two or more neck ultrasounds, one or more radioactive iodine scan, and one or more additional imaging study.
  • Moderate maximizers were more likely vs minimizers to have ≥ 2 neck ultrasounds and ≥ 1 additional imaging test.

The investigators concluded, “Among patients with thyroid cancer who have been declared disease-free, preference for a more maximal vs minimal approach to medical care is associated with increased number of physician visits and imaging tests. Because increased surveillance does not clearly correlate with improved outcomes, poses potential risks to patients, and contributes to increased health-care costs, stronger consideration of the role of patient preferences is necessary when framing discussions on surveillance."

Megan R. Haymart, MD, of the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by a grant from the National Cancer Institute. 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®.
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