Updated 10 April 2019

Drop the word 'cancer', and patient choices change

There's a growing consensus among cancer doctors that removal of the thyroid gland is an overreaction in most thyroid cancers.

Patients may say no to unnecessary surgery for low-risk thyroid cancer if doctors simply avoid using the word "cancer" when discussing treatment options, a new study, published online in the journal JAMA Otolaryngology – Head & Neck Surgery, suggests.

Nearly twice as many people wanted their entire thyroid removed when doctors used the wording "papillary thyroid cancer", as opposed to a "papillary lesion" or "abnormal cells", the Australian researchers found.

Keeping a watchful eye

Doctors should "be aware of the impact that the term 'cancer' has on patients' anxiety and treatment preferences, which in turn may be driving potential over diagnosis and over treatment of some low-risk cancers, such as papillary thyroid cancer," said senior researcher Kirsten McCaffery, a behavioural scientist with the University of Sydney's School of Public Health.

Most cases of thyroid cancer can be treated either by partial removal of the gland or by simply keeping a watchful eye on the cancer, the study authors explained in background notes. Large cancer centres currently put most thyroid cancer cases under observation, but smaller hospitals still opt for surgical removal of the gland, said Dr Otis Brawley, chief medical and scientific officer for the American Cancer Society.

Any diagnosis of cancer can be "terrifying and shocking to hear", McCaffery said.

To see whether the emotional response to the word is influencing treatment decisions, McCaffery and her colleagues presented 550 healthy adult Australians with a series of three different hypothetical medical scenarios.

Surgery not necessarily the best option

All three scenarios were based on a diagnosis of papillary thyroid cancer. About eight out of 10 thyroid cancers are papillary cancers, which tend to grow very slowly and usually develop in only one lobe of the thyroid gland, according to the American Cancer Society.

However, doctors referred to papillary thyroid cancer in only one of the three scenarios. In the other two, they used different terms to describe the same condition: papillary lesion, or abnormal cells.

About 20% of people wanted their whole thyroid removed when the word cancer was used. Only about 11% of the same people opted for full thyroid removal when it was called a papillary lesion or abnormal cells.

People presented the papillary thyroid cancer scenario more often chose surgery over active surveillance than participants told of papillary lesions or abnormal cells, and they also experienced higher levels of anxiety.

Surgery is not necessarily the best option to treat some cancers, Dr Brawley said. Prostate cancer is the most well-known example of this, but another is bladder cancer.

The scoring method for prostate cancer has been altered to make low-risk tumours seem less frightening to patients, Dr Brawley explained, and urologists and pathologists have removed the word "cancer" from some bladder pathologies.

"We have proven that what looks like cancer under the microscope is not necessarily cancer. It's something that may not grow, spread and kill," Brawley said. At this time, McCaffery wouldn't recommend that doctors omit the word "cancer" when discussing papillary thyroid cancer with patients, since doing so would not be medically ethical.

"We hope that our findings will add to the evidence on the impact that the cancer term may have on patients, which may help progress current international discussion and debate among cancer experts about the reclassification of these low-risk tumours," McCaffery said.

International experts have previously called for low-risk cancers like papillary thyroid cancer to be reclassified, with the term "cancer" removed because the tumours are not likely to spread or kill, she said.

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