Abstract
Background: Patient perspectives on risks vs benefit tradeoffs for thyroid cancer treatment options are important but not well studied. Our aim was to conduct a stated-preference study to characterize patients’ views on the relative importance of various risks/benefits associated with lobectomy and total thyroidectomy for management of low-risk thyroid cancer. Methods: Adult patients with low-risk thyroid cancer or a thyroid nodule requiring surgery enrolled in a prospective survey-based discrete-choice experiment (DCE) to quantify benefit-risk tradeoffs pertaining to surgical management. Patients were asked to assume they had thyroid cancer for the purpose of the study; they were asked to choose between experimentally-designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), hypocalcemia (0%, 3%, 8%), risk of requiring a second surgery (0%, 40%), cancer recurrence (1%, 3%, 5%), and need for daily thyroid hormone supplementation (yes, no). Their choices were analyzed using a random-parameters logit model to estimate the relative influence of each feature on patients’ stated preferences for surgery. The resulting estimates were used to evaluate preferences for surgical profiles representing lobectomy and total thyroidectomy. Results: From 2017-18, we enrolled 132 patients. Median age was 58 years; 79.9% were female. 83% had a thyroid nodule as the primary diagnosis; 16% hypo-/hyperthyroidism; 21% were on thyroid medications. On average, 35% of patients’ choices were explained by the difference in the risk of thyroid cancer recurrence across surgeries, and 28% of choices by the risk of requiring a second surgery. Changes in the risk of nerve damage explained 18% of their choices, while differences in the risk of hypocalcemia and the need for thyroid hormone supplementation explained 10% and 8% of choices, respectively. When inferring patients’ preferences for clinical profiles representing lobectomy and total thyroidectomy, we found that patients would generally favor total thyroidectomy largely due to their negative views on an assumed 40% risk of requiring a second surgery with lobectomy. However, if the risk of needing a second surgery after lobectomy can be reduced below 30%, the average patient would start favoring lobectomy over total thyroidectomy, based on assumptions pertaining to the difference in the risks of nerve damage and hypocalcemia between lobectomy and total thyroidectomy. Conclusions: Patients’ preferences for lobectomy or total thyroidectomy will vary depending upon combinations of risks and benefits of both procedures that apply to the individual patient. Appropriate preoperative evaluation to decrease the chance of a second surgery, excellent physician-patient communication, and surgeon experience are important for providing patients with a good understanding of risks and benefits associated with extent of surgery.