Nickel B, et al. - Authors ascertained the association of treatment preferences and anxiety levels for papillary thyroid cancer (PTC) with the terminology used to describe the condition. In order to reduce patients’ anxiety levels and help them consider less invasive management options, one strategy could be changing the terminology of small PTCs. Providing balanced information about the risks and advantages of alternative treatments may be other strategy to curtail overdiagnosis and overtreatment in PTC.

Methods

• In this randomized crossover study, experts involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer.
• Between March 16, 2016, and July 26, 2016, an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells was assessed by the participants.
• They exposed the participants to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies.
• They conducted the data analysis from September 1, 2016, to May 15, 2017.
• Main outcomes and measures included the treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety.

Results

• As per data, of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years.
• Findings suggested that total thyroidectomy was chosen by higher proportion of participants (108 [19.6%]) when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used.
• At first exposure, 60 of 186 participants (32.3%) were led by the papillary thyroid cancer terminology to choose surgery vs 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first.
• After the first exposure, significantly higher levels of anxiety were reported by the participants who viewed papillary thyroid cancer terminology (mean,7.8 of 11 points) vs those who viewed the papillary lesion (mean,7.0 of 11 points; mean difference, –0.8; 95% CI, –1.3 to –0.3) or abnormal cells (mean,7.3 of 11 points; mean difference, –0.5; 95% CI, –1.0 to 0.01).
• Overall, regardless of which terminology was viewed first, high interest in active surveillance and higher levels of anxiety were noted by those who chose surgery, (mean difference, 1.5; 95% CI, 1.0-1.9).