Determinants of physicians' risk-benefit perceptions of adjuvant radioactive iodine for differentiated thyroid cancer.

IF 3.3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Carlos Garcia-Regal, Jhonatan Quiñones-Silva, Alberto Martinez-Lorca, Noemi Brox-Torrecilla, Sandra Campos Mena, Teresa Alonso-Gordoa, Joaquín Gómez-Ramírez, Pablo Valderrabano
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Abstract

Purpose: Selective use of radioactive iodine is advocated in recent guidelines. We aimed to characterize clinical practice and factors associated with its prescription in low- or intermediate-risk differentiated thyroid cancer patients among Spanish physicians.

Methods: A cross-sectional survey was conducted in 2022 among Spanish physicians. The survey assessed preferences for radioactive iodine administration in different differentiated thyroid cancer clinical scenarios with excellent response to surgery.

Results: Ninety-six responses were received. In low-risk differentiated thyroid cancer, radioactive iodine was most often used to facilitate follow-up (40%), or to reduce the risk of recurrence (23%). Activity of radioactive iodine was selected according to treatment intention by 96% of respondents; but more than 50% of low-risk differentiated thyroid cancer patients received radioactive iodine treatment in the clinical setting of 2/3 of the respondents; and 13% routinely recommend adjuvant activities in this setting. In intermediate-risk differentiated thyroid cancer, the main objective of radioactive iodine administration was to reduce the risk of recurrence (81-83%). Adjuvant radioactive iodine was perceived to be well or very well tolerated (96% of respondents); with a positive risk-benefit balance in patients with low-risk (50%) or intermediate-risk (90%) differentiated thyroid cancer. Factors influencing physicians' likelihood to recommend radioactive iodine included an overestimation of its benefits; and underestimation of its risks; and perceived increased risk with increasing tumor size, nodal involvement, BRAF V600E mutation, and follicular/oncocytic histology.

Conclusions: This survey shows discrepancy between reported clinical practice and current consensus guidelines as well as variation in practice patterns in Spain regarding [131I]NaI treatment.

医生对分化型甲状腺癌使用辅助放射性碘的风险-收益认知的决定因素
目的:在最近的指南中提倡选择性使用放射性碘。我们的目的是描述西班牙医生中低风险或中度分化甲状腺癌患者的临床实践及其处方相关因素。方法:于2022年对西班牙医生进行横断面调查。该调查评估了对手术反应良好的不同分化甲状腺癌临床情况下放射性碘给药的偏好。结果:共收到96份回复。在低风险分化型甲状腺癌中,放射性碘最常用于促进随访(40%)或降低复发风险(23%)。96%的应答者根据治疗意向选择放射性碘活度;但超过50%的低危分化型甲状腺癌患者在2/3的应答者的临床环境中接受了放射性碘治疗;13%的人建议在这种情况下进行常规辅助治疗。在中危分化型甲状腺癌中,放射性碘治疗的主要目的是降低复发风险(81-83%)。人们认为辅助放射性碘耐受良好或非常良好(96%的应答者);低危(50%)或中危(90%)分化型甲状腺癌患者的风险-收益平衡为正。影响医生推荐放射性碘的因素包括:对其益处的高估;以及对风险的低估;随着肿瘤大小、淋巴结累及、BRAF V600E突变和滤泡/癌细胞组织学的增加,风险也随之增加。结论:该调查显示了西班牙关于[131I]NaI治疗的临床实践与当前共识指南之间的差异,以及实践模式的差异。
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来源期刊
Endocrine
Endocrine ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
5.40%
发文量
295
审稿时长
1.5 months
期刊介绍: Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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