Evidence map›Paper›PMID 32475718›Full record

ArticleSurgery2021

Understanding surgical decision-making in older adults with differentiated thyroid cancer: A discrete choice experiment.

Whitney Sutton, Becky Genberg, Jason D Prescott, Dorry L Segev, Martha A Zeiger, Karen Bandeen-Roche, Aarti Mathur

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.6field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 9 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Whitney SuttonDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: wsutton9@jhmi.edu.
Becky GenbergDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jason D PrescottDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Dorry L SegevDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Martha A ZeigerSurgical Oncology Program, National Cancer Institute, National Institute of Health, Bethesda, MD.
Karen Bandeen-RocheDepartment of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Aarti MathurDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Johns Hopkins University · USNational Cancer Institute · US

Funding

Technological Assessment and Solutions Core - RC4P30AG021334 · NIA · JOHNS HOPKINS UNIVERSITY · PI Jeremy D Walston · 2003 to 2026
$33.2M
Training and Development of Outstanding Surgeon ScientistsZIEBC011992 · NCI · DIVISION OF BASIC SCIENCES - NCI · PI ZEIGER, MARTHA · 2020 to 2024
$9.6M
Association of Fraility with Post thyroidectomy alterations in Voice, Swallowing, and Quality of LifeK23AG053429 · NIA · JOHNS HOPKINS UNIVERSITY · PI MATHUR, AARTI · 2017 to 2022
$1.0M
NIA NIH HHS K23 AG053429NIA NIH HHS P30 AG021334
6 · The paper itself

Abstract

backgroundPrior studies demonstrated that older adults tend to undergo less surgery for thyroid cancer. Our objective was to use a discrete choice experiment to identify factors influencing surgical decision-making for older adults with thyroid cancer.

methodsActive and candidate members of the American Association of Endocrine Surgeons were invited to participate in a web-based survey. Multinomial logistic regression was utilized to assess patient and surgeon factors associated with treatment choices.

resultsComplete survey response rate was 25.7%. Most respondents were high-volume surgeons (88.5%) at academic centers (76.9%). Multinomial logistic regression demonstrated that patient age was the strongest predictor of management. Increasing age and comorbidities were associated with the choice for active surveillance (P = .000), not performing a lymphadenectomy in patients with nodal metastases (relative-risk ratio: 2.5, 95% CI: 1.4-4.2, P = .002 and relative-risk ratio: 1.6, 95% CI: 1.2-2.1, P = .004, respectively), and recommending hemithyroidectomy versus total thyroidectomy for a cancer >4 cm (relative-risk ratio: 4.4, 95% CI: 2.5-7.9, P = .000 and relative-risk ratio: 3.4, 95% CI: 2.3-5.1, P = .000, respectively). Surgeons with ≥10 years of experience (relative-risk ratio: 3.3, 95% CI: 1.1-10.3, P = .039) favored total thyroidectomy for a cancer <4 cm, and nonfellowship trained surgeons (relative-risk ratio: 7.3, 95% CI: 1.3-42.2, P = .027) opted for thyroidectomy without lymphadenectomy for lateral neck nodal metastases.

conclusionThis study highlights the variation in surgical management of older adults with thyroid cancer and demonstrates the influence of patient age, comorbidities, surgeon experience, and fellowship training on management of this population.

Indexed as

Clinical Decision-MakingAdultAgedAged, 80 and overAge FactorsClinical CompetenceComorbidityFemaleFunctional StatusHumansLogistic ModelsLymphatic MetastasisLymph Node ExcisionLymph NodesMaleMiddle Aged

Identifiers

PMID32475718
PMCPMC7704531
OpenAlexW3032707274

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.