Active Thyroid Surveillance Benefits Older Patients
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Active Surveillance: A Promising Option for Older Patients with Low-Risk Thyroid Cancer
Toronto, ON – For older individuals diagnosed with small, low-risk papillary thyroid cancer, a “watch and wait” approach - known as active surveillance – may be a safe and effective option to immediate surgery, according to new research published august 20 in JAMA Surgery. The study, led by Dr. Anna Sawka from Toronto General Hospital, offers encouraging news for patients seeking to avoid unnecessary procedures.
The research team followed 200 patients with an average age of 52, with 155 opting for active surveillance and 45 choosing immediate surgery. Over a median follow-up of 71 months, the study found no thyroid cancer-related deaths or distant spread of the disease.Importantly, more than three-quarters of those who initially chose active surveillance continued on this path, without needing surgery, as long as their cancer didn’t progress.
“We were struck by how durable active surveillance was, particularly in older patients,” Dr. Sawka told AuntMinnie.com. “The findings reinforce the central role of high-quality ultrasound imaging in safely monitoring small, low-risk thyroid cancers over time.”
Active surveillance involves regular monitoring with ultrasound exams and blood work, typically every six months for the first two years, then annually if findings remain stable. This approach is gaining traction as a viable option for low-risk, early-stage cancers, and this study highlights the importance of a thorough discussion between doctors and patients about the benefits and risks of each approach, taking age into consideration.The study found that the rate of switching from active surveillance to surgery (crossover rate) was 23.9% (37 patients). The primary reasons for this crossover were disease progression (56.8%), patient preference (40.5%), and, in a small number of cases (2.6%),limitations in ultrasound imaging. One case involved a patient with Hashimoto’s thyroiditis, where distinguishing the tumor from the surrounding tissue proved tough.
Notably,the crossover rate varied significantly with age. Patients under 45 had a 41.5% crossover rate, compared to 20.9% for those aged 45-64, and a remarkably low 5.1% for patients 65 and older. This suggests that older individuals are more likely to remain on active surveillance long-term.
Dr. sawka and her team emphasize the importance of informed decision-making.They advocate for providing patients with clear information about their options, including the potential benefits and drawbacks of both active surveillance and surgery. This research provides further evidence that active surveillance is a safe and effective option for many patients, particularly older adults, with low-risk thyroid cancer, possibly avoiding unnecessary surgical interventions.
Key Takeaways:
Active surveillance is a durable option for managing low-risk papillary thyroid cancer.
Older patients are more likely to remain on active surveillance long-term.
High-quality ultrasound imaging is crucial for safe and effective monitoring.
Informed patient counseling is essential to help individuals choose the best treatment path based on their age and preferences.
Resources:
American Thyroid Association: https://www.thyroid.org/thyroid-information/
cleveland Clinic: https://my.clevelandclinic.org/health/body/23188-thyroid
MedicineNet: https://www.health.com/condition/thyroid