A paper recently published in Endocrine Reviews is addressing the controversies that exist in managing low-risk differentiated thyroid cancer (DTC), since these controversies expose patients to the risk of being over- or undertreated.
The review, by Megan R. Haymart, MD, of the University of Michigan, et al, points out that the controversies extend across all aspects of management, from surgery to use of radioiodine to long-term surveillance. Compounding these problems are evolving clinical guidelines and inconsistencies in existing data, since many of the current studies are limited by small sample sizes and shorter-than-optimal follow-up. In addition, preferences for treatment can vary from physician to physician, and from patient to patient. Patient anxiety can also factor into treatment decision making.
Things seem to be moving in the right direction, but that means more studies are needed. The authors write that “the pendulum only recently swung toward less intensive treatment of low-risk DTC; therefore, there has not been enough time to assess how this practice change will impact long-term surveillance. Additional long-term outcomes data are needed prior to definitively defining optimal surveillance in an era of ‘less is more.’”
The authors conclude the review by calling for increasing physician consensus to reduce these controversies. They also call for improving patient care by designing “rigorous studies to address current knowledge gaps” and to disseminate this data to educate both patients and physicians when quality data exist.