BACKGROUND
Most of the time, when a thyroid nodule biopsy reveals a nodule is a cancer, the next step is surgery to remove the thyroid. However, recent data shows that small cancers (<1 cm) are usually low risk for growing and spreading. This has led to the option of following the nodule by ultrasound rather than moving to immediate surgery. This is called active surveillance. Active surveillance is becoming an acceptable option in the management of small low-risk papillary thyroid cancer. For those patients in active surveillance, if their cancer were to grow over time or spread to lymph nodes in the neck, surgery would be recommended. Most patients who choose active surveillance do not experience cancer growth and do not require surgery. However, the quality of life of these patients, including anxiety or worries about a possible cancer growth has not been properly looked at in a long-term fashion. This study was done to compare the quality of life over time of patients who chose active surveillance and those who chose immediate surgery for small, low risk papillary thyroid cancer.

THE FULL ARTICLE TITLE
Kazusaka H et al 2023 Patient-reported outcomes in patients with low-risk papillary thyroid carcinoma: Cross-sectional study to compare active surveillance and immediate surgery. World J Surg 47:1190–1198. PMID: 36282283

SUMMARY OF THE STUDY
A total of 281 patients who were seen in a single hospital in Japan were included in the study. The majority (88%) were in the active surveillance group. Only 11% had immediate surgery. They were followed for more than 5 years. The patients were asked to complete three questionnaires that looked at the quality of life, anxiety (assessing their baseline personality trait and in relationship to their situation) and neck symptoms. The active surveillance group had better health and mental scores and lower baseline anxiety levels and as well as lower anxiety scores over time. The surgery group reported more neck symptoms, such as discomfort and difficulty swallowing.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study is important since it shows that overall measures of quality of life are better in patients opting for active surveillance for their low risk papillary thyroid cancers. It also appears that in general the anxiety level in patients who choose active surveillance is lower at baseline and does not increase over time while their cancer is being monitored. These results should encourage physicians to be less hesitant about recommending active surveillance for those patient with small thyroid cancers.

— Susana Ebner MD

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