By Dennis Thompson HealthDay Reporter
THURSDAY, Aug. 23, 2018 (HealthDay News) --
Patients may say no to unnecessary surgery for low-risk thyroid cancer if
doctors simply avoid using the word "cancer" when
discussing treatment options, a new study suggests.
Nearly twice as many people wanted their
entire thyroid removed when doctors used the wording "papillary
thyroid cancer,"
as opposed to a "papillary lesion" or "abnormal cells," the
Australian researchers found.
Doctors should "be aware of the impact
that the term 'cancer'
has on patients' anxiety and
treatment preferences, which in turn may be driving potential overdiagnosis and
overtreatment of some low-risk cancers, such as papillary
thyroid cancer," said senior researcher Kirsten McCaffery. She's a
behavioral scientist with the University of Sydney's School of Public Health.
There's a growing consensus among cancer
doctors that removal of the thyroid gland is an overreaction in most thyroid
cancers.
Most cases of thyroid cancer can be treated
either by partial removal of the gland or by simply keeping a watchful eye on
the cancer, the study authors explained in background notes.
Four out of five patients who have surgery to
treat thyroid cancer undergo a full removal of the gland, even though only
about 2 percent of people die from their thyroid cancer over 25 years, recent
research has shown.
Part of the problem stems from doctors'
preferences. Large cancer centers currently put most thyroid cancer cases under
observation, but smaller hospitals still opt for surgical removal of the gland,
said Dr. Otis Brawley, chief medical and scientific officer for the American
Cancer Society.
But patients also have a say in their care,
and that could be influencing the decision to remove the entire thyroid in
cases where that simply isn't needed, the Australian researchers said.
Any diagnosis of cancer can be
"terrifying and shocking to hear," McCaffery said. "Many
patients we've interviewed report not being able to think of anything else once
the word 'cancer' is used."
To see whether the emotional response to the
word is influencing treatment decisions, McCaffery and her colleagues presented
550 healthy adult Australians with a series of three different hypothetical
medical scenarios.
All three scenarios were based on a diagnosis
of papillary thyroid cancer. About eight out of 10 thyroid cancers are
papillary cancers, which tend to grow very slowly and usually develop in only
one lobe of the thyroid gland, according to the American Cancer Society.
However, doctors referred to papillary thyroid
cancer in only one of the three scenarios. In the other two, they used
different terms to describe the same condition: papillary lesion; or abnormal
cells.
About 20 percent of people wanted their whole
thyroid removed when the word cancer was used. Only about 11 percent of the
same people opted for full thyroid removal when it was called a papillary
lesion or abnormal cells.
People presented the papillary thyroid cancer
scenario more often chose surgery over active surveillance than participants
told of papillary lesions or abnormal cells, and they also experienced higher
levels of anxiety.
Surgery is not necessarily the best option to
treat some cancers, Brawley said. Prostate canceris
the most well-known example of this, but another is bladder cancer.
Doctors treating those cancers have been
adjusting their language to make active surveillance a more palatable option
for patients, he added.
The scoring method for prostate
cancer has been altered to make low-risk tumors seem less
frightening to patients, Brawley explained, and urologists and pathologists
have removed the word "cancer" from some bladder pathologies.
"We have proven that what looks like
cancer under the microscope is not necessarily cancer. It's something that may
not grow, spread and kill," Brawley said.
"For the last 100 years, people have been
taught if you find cancer, cut it out. We need to change that teaching and
realize that certain cancers need to be treated less aggressively,"
Brawley said. "That would be my preference. I don't know if that's
doable."
At this time, McCaffery wouldn't recommend
that doctors omit the word "cancer" when discussing papillary thyroid
cancer with patients, since doing so would not be medically ethical.
"We hope that our findings will add to
the evidence on the impact that the cancer term may have on patients, which may
help progress current international discussion and debate amongst cancer
experts about the reclassification of these low-risk tumors," McCaffery
said.
International experts have previously called
for low-risk cancers like papillary thyroid cancer to be reclassified, with the
term "cancer" removed because the tumors are not likely to spread or
kill, she said.
"Our work adds further evidence to
support this call for reclassification and the consideration of redefining what
we call cancer," McCaffery said. "Important cancer organizations,
cancer patient groups and citizens also need to be consulted on this topic and
included in this debate."
The new study was published online Aug. 23 in
the journal JAMA Otolaryngology--Head & Neck Surgery.
Copyright © 2018 HealthDay. All rights
reserved.
SOURCES:
Kirsten McCaffery, Ph.D., behavioral scientist, University of Sydney's School
of Public Health, Australia; Otis Brawley, M.D., chief medical and scientific
officer, American Cancer Society; Aug. 23, 2018, JAMA Otolaryngology-Head &
Neck Surgery, online
No comments:
Post a Comment