Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for...

Area of Science:

• Endocrinology
• Surgical Oncology
• Patient-Reported Outcomes

Background:

• Low-risk thyroid cancer (TC) management often involves total thyroidectomy (TT), potentially driven by emotional responses to diagnosis rather than patient-prioritized outcomes.
• Discrepancies exist between patient preferences and actual outcomes following TT for low-risk TC.

Purpose of the Study:

• To determine the relative importance of various treatment outcomes for patients diagnosed with low-risk thyroid cancer.
• To assess how patient valuation of treatment outcomes changes from the pre-treatment decision phase to 9 months post-treatment.

Main Methods:

• A prospective, multi-institutional, longitudinal cohort study included adults with low-risk TC.
• Participants allocated 100 points to 10 outcomes at diagnosis and 9 months later.
• Statistical analyses (t-tests, Hotelling's T²) compared outcome valuation based on surgical extent (TT vs. lobectomy).

Main Results:

• Patients opting for TT initially prioritized lower recurrence risk and less need for thyroid hormone replacement compared to lobectomy patients.
• Post-treatment, all patients de-emphasized cancer removal and voice impact, while increasing the importance of energy levels.
• The perceived importance of recurrence risk shifted: increasing for lobectomy patients and decreasing for TT patients.

Conclusions:

• Patient priorities for low-risk thyroid cancer treatment outcomes evolve post-experience, favoring quality of life over emotion-driven factors.
• Findings suggest surgeons should discuss potential impacts on energy levels (asthenia) associated with total thyroidectomy.