ホリウチ キヨミ   Horiuchi Kiyomi
  堀内 喜代美
   所属   医学部 医学科(東京女子医科大学病院)
   職種   准教授
論文種別 原著
言語種別 英語
査読の有無 査読なし
表題 Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery.
掲載誌名 正式名:Thyroid : official journal of the American Thyroid Association
略  称:Thyroid
ISSNコード:15579077/10507256
掲載区分国外
巻・号・頁 30(5),pp.681-687
著者・共著者 Yoshida Yusaku, Horiuchi Kiyomi, Okamoto Takahiro
担当区分 2nd著者
発行年月 2020/05
概要 Background:
Clinical practice guidelines have endorsed both active surveillance and surgery as viable management options for papillary thyroid microcarcinoma (PTMC). However, patients' perceptions on the options have rarely been addressed.
Methods:
A cross-sectional survey was conducted on 50 patients with PTMC who were under either active surveillance (n = 20) or postoperative follow-up (n = 30). The primary outcome was anxiety, which was measured using the State-Trait Anxiety Inventory (STAI). A questionnaire that comprised six items about PTMC-related symptoms and concerns, which were measured with a visual analog scale, was also administered. Cohen's d effect size was calculated to express group differences. Multiple regression analysis was used to examine the relationships between state anxiety and other variables.
Results:
The median age and observation period were 61.5 years (range, 40-83 years) and 4.1 years (range, 0-8.6 years), respectively. The female/male ratio was 38/12. Compared with the surgery group, the active surveillance group showed higher scores in both state anxiety and trait anxiety, with corresponding effect sizes of 0.55 (confidence interval [CI] -0.03 to 1.1; p = 0.068) and 0.63 (CI 0.02-1.2; p = 0.037), respectively. Trait anxiety (β = 0.83) and observation time (β = -1.57) were the significant predictors of state anxiety. Moderate effect sizes were observed for "discomfort in the neck" (-0.53; CI -1.11 to 0.04); "weak voice" (-0.46; CI -1.03 to 0.12); and "nervous about neck appearance" (-0.64; CI -1.23 to -0.07), in favor of active surveillance.
Conclusions:
State anxiety among patients with PTMC seemed to be a reflection of an individual's trait rather than management. Understanding the patients' view appears to be key to improve shared decision-making.
DOI 10.1089/thy.2019.0420
PMID 31910100