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Patient and surgeon perspectives on the American Thyroid Association (ATA) 2015 & British Thyroid Association (BTA) 2014 guidelines in the management of “Low-Risk” Thyroid Cancers (LRDTCs): Two sides of the coin
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  • Hiro Ishii,
  • Iain Nixon,
  • John Watkinson,
  • Kate Farnell,
  • Samuel Chan,
  • Dae Kim
Hiro Ishii
Saint George's University Hospitals NHS Foundation Trust

Corresponding Author:[email protected]

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Iain Nixon
Department of Otolaryngology, Head & Neck Surgery, Edinburgh Cancer Centre, Western General Hospital
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John Watkinson
Great Ormond Street Hospital For Children NHS Foundation Trust
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Kate Farnell
Butterfly Thyroid Cancer Trust
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Samuel Chan
Saint George's University Hospitals NHS Foundation Trust
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Dae Kim
Saint George's University Hospitals NHS Foundation Trust
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Objectives: To investigate how surgeons interpret the ATA 2015 and BTA 2014 guidelines for low risk well differentiated thyroid cancers (LRDTCs) and how they impact patient experiences across the UK. Design: Three nationally disseminated anonymised questionnaires. Setting: A nationwide snapshot of LRDTC management. Participants: Thyroid surgeons and their respective thyroid cancer multidisciplinary teams (MDTs) and thyroid cancer patients. Main outcome measures: The outcomes of interest were how surgeons/MDTs are managing LRDTCs and patient perspectives on ‘shared-decision-making’ and their ideal surgical management for LRDTCs. Results: 74 surgeons responded. 88% utilised BTA guidelines to assess recurrence risk. Tumour size, histology, stage T3b and central nodal involvement were important for >85%, but age (>45 years) only for 50%. In T1 (2cm), Thy5 solitary nodule, 58% supported hemi-thyroidectomy (HT), with 33% for total thyroidectomy (TT). In T2 (3cm) PTC, 54% opted for TT, with 24% favouring HT. Over 90% recommended TT for any incidentally excised microscopically positive lymph nodes. In T1a(m) multifocal micro-PTC, 63% suggested HT, but with contralateral benign nodules, 66% supported TT. 40% of patients felt ‘pros and cons’ of different managements were not fully explained. 47% felt they didn’t have significant input in their management, with 53% feeling final management was clinician’s choice. 60% preferred TT, with 80% wanting to ensure there was no cancer left and avoid recurrence. 20% preferred HT, with 46% wishing to avoid lifelong thyroxine. Conclusions: There is variation in risk assessment and management of LRDTCs nationally, with contrasting views of optimum treatment between patients and clinicians. These variations in practice are affecting patient experiences nationally.
17 Apr 2020Submitted to Clinical Otolaryngology
21 Apr 2020Assigned to Editor
21 Apr 2020Submission Checks Completed
26 Apr 2020Editorial Decision: Revise Minor