The word "cancer" in the description of papillary thyroid cancer low risk can lead to the fact that patients with this diagnosis will choose aggressive treatment, and this may increase their anxiety.
When participants were asked three hypothetical scenarios of papillary thyroid cancer, are more likely to choose non-surgical options such as active surveillance, when the word "cancer" was excluded from the description of the disease.
They also reported that they feel less concerned with such a formulation of the diagnosis.
The results were published online Aug. 23 in JAMA Otolaryngology-Head and Neck Surgery.
At the present time, despite studies showing that papillary thyroid cancer has a benign course, and that active surveillance is a viable option for its management, many patients prefer to undergo a full or partial thyroidectomy, an expensive option that is associated with the surgical risk, life-long reception drugs.
"In everyday practice it is very difficult to lead a very quiet conversation with patients, when you start with the word" cancer ", - he said.
"At this point, the patient's anxiety and fear are the dominant factors that influence decision-making, and you do not want this for their patients. You want your patients have a good environment for learning, what treatments have for their meaning and that their decisions are not a reflection of anxiety Fear ", - said Brito.
In 2016, as reported by Medscape Medical News, an international group of pathologists and clinicians changed the name of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), the type of non-invasive cancer that has a low risk of relapse, non-invasive follicular neoplasm of the thyroid gland with papillary-like nuclear properties (NIFTP).
Experts believe that the change in nomenclature will eliminate the psychological effects of receiving a cancer diagnosis, as well as reduce the excessive processing costs and risks associated with a more aggressive management.
In the current study, the researchers presented 550 adults who had no history of thyroid cancer with clinically realistic scenario with a diagnosis of papillary thyroid cancer.
Conditions were described using the following terms:
- Papillary thyroid cancer.
- Papillary lesion.
- Abnormal cells.
Study participants were randomized to show that the terms are arranged in different orders. A third of the participants first saw the cancer, the term "papillary thyroid cancer", the third - "papillary lesion", the third - "abnormal cells".
Each time a participant has seen one of the three conditions, the researchers recorded which of the following treatment options he or she chooses:
- Total thyroidectomy.
- active surveillance
anxiety levels among participants were measured on a visual analog scale.
Participants extensive information on forecasts and treatment options were provided, including the probability of tumor growth and its invasiveness and the possibility of death by the state over the next 20 years, depending on what kind of treatment option has been selected.
"We tried to give them as much information as we could to help them get the best available data to make a decision about which treatment option they prefer," - he explained lead author Brooke Nickel, Bachelor, University of Sydney, Australia, in the podcast JAMA
A higher proportion of participants (n = 108, 19.6%) chose total thyroidectomy as treatment, when the term "papillary thyroid cancer" is used to describe the state than the participants who have selected a total thyroidectomy, when the terms "papillary lesion" (n = 58; 10.5%) or "abnormal cells» (n = 60, 10.9%).
In addition, participants reported significantly higher levels of anxiety when the diagnosis has been given to the use of the term "thyroid papillary carcinoma" compared to the other two terms.
The order in which the participants considered different terms, also have been a factor in the treatment of their preferences.
Among the 186 participants, who saw for the first time the term "papillary thyroid cancer", 60 (32.3%) chose surgery. For comparison, 46 out of 191 participants (24.1%) chose surgery, first saw term "papillary defeat" (hazard ratio [RR], 0,73) and 47 of the 173 participants (27.2%) chose the operation seeing The term "abnormal cells" "first (RR, 0,82).
"These findings point to the importance of discussing the consequences of papillary thyroid cancer patients to help mitigate any potential associated with this concern," - said in the podcast Nickel JAMA.
The study also showed that the total interest for active surveillance of 72%, no matter what the term is used. "It was higher than we expected," - said Nickel.