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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
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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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Peer review status:IN REVISION

17 Apr 2020Submitted to Clinical Otolaryngology
21 Apr 2020Assigned to Editor
21 Apr 2020Submission Checks Completed
26 Apr 2020Editorial Decision: Revise Minor

Abstract

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.