Is Thyroid Cancer a "Good Cancer?"

Physicians caring for patients who have just received a diagnosis of thyroid cancer vary in their responses to the patients' worry, according to a new study. About half of the 448 physicians surveyed said that they tell patients that thyroid cancer, in the grand scheme of things, is ''a good cancer."

Although the prognosis of thyroid cancer is generally excellent, ''Currently no evidence suggests that telling thyroid cancer patients they have a 'good cancer' is helpful or reassuring,'' said Maria Papaleontiou, MD, the lead author of the study and assistant professor of medicine at the University of Michigan in Ann Arbor.

"On the contrary," she said, ''patients report that being told by doctors that they have a 'good cancer' invalidates their fears of having cancer and creates mixed and confusing emotions."

The study, supported by grants from the National Institute on Aging and the National Cancer Institute, was accepted for presentation at ENDO 2020, the virtual annual meeting of the Endocrine Society.

Study Details

For the study, the researchers used the SEER (Surveillance, Epidemiology, and End Results Program) registries of Georgia and Los Angeles County, first asking patients diagnosed with differentiated thyroid cancer in 2014 and 2015 to identify endocrinologists and surgeons involved in managing their cancer.

Physicians were asked to describe their thyroid cancer patients' worry when they were diagnosed and what the physicians told them if they were worried. Next, the researchers used a multivariable logistic regression to identify physician characteristics associated with reporting thyroid cancer as a ''good cancer'' to the patient.

The response rate to the survey was 69%, or 448 of 654 physicians. Of that, 40% were endocrinologists, 30% general surgeons, and 30% otolaryngologists. How it broke out:

• 8% said their patients are not worried or only a little

• 27% said their patients were somewhat worried

• 65% said their patients were quite or very worried

As for how the physicians handled the worry:

• 91% said they gave details on prognosis, including information on death rates and recurrence

• 50% told patients that thyroid cancer is a ''good cancer"

Who was most likely to call thyroid cancer a ''good cancer?" Otolaryngologists were about two times as likely, compared to endocrinologists. Private practice physicians were more likely than academic-based doctors. And Los Angeles physicians were more likely than those in Georgia.

Those who perceived their patients as quite or very worried were less likely to call it a good cancer (OR 0.55,95% CI 0.35-0.84) and more likely to urge patients to seek help outside the patient-physician relationship (OR 1.82, 95% CI, 0.35-0.84), compared to those whose patients were not worried or somewhat worried.

Thyroid Cancer by the Numbers

According to the American Cancer Society, 5-year relative survival rates for localized papillary, follicular, and medullary thyroid cancer is near 100% (for localized anaplastic, it is much lower, 31%, but the new study focused on differentiated thyroid cancer.)

For 2020, the ACS estimate about 53,000 new cases of thyroid cancer and about 2,100 deaths.

Analysis and Discussion

"There continues to be lack of clarity about the physicians' responsibility to provide psychosocial care to cancer survivors, with significant variation among different specialists regarding knowledge and confidence in delivering such care," Dr. Papaleontiou said. Physicians try to focus on optimistic outcomes, she said, which is understandable. ''However, calling thyroid cancer a 'good cancer' may invalidate the patients' feelings around receiving a cancer diagnosis."

More physician education is needed, she said, so doctors will recognize that the worry is real and direct those patients who need it to formal psychological and emotional support and care, she said.

Expert Perspectives

Sarah Oltmann, MD, FACS, is an assistant professor of surgery at UT Southwestern Medical Center in Dallas, and a thyroid cancer survivor. She reviewed the findings for and can see both sides.

"As a doctor, we have a different frame of reference," she said. "We see the full spectrum of cancers." So differentiated thyroid cancer, with its generally good prognosis, is viewed on a continuum with cancers that do not have such a good prognosis.

"I tell patients, 'It's OK to grieve hearing that word cancer,''' she said. "It doesn't matter that it is not the same as going through pancreatic cancer."

When Dr. Oltmann learned she had thyroid cancer, "I went through that grieving process, but I felt guilty about it, because I did have that doctor's frame of reference."

When she diagnoses an individual with thyroid cancer, she does not use the word ''good'' cancer, she said. Nor can physicians assume they know if their patients are worried or not. Many are, as research shows. She advises physicians treating individuals with thyroid cancer to go to support groups, chat rooms, and Facebook groups dedicated to thyroid cancer patients to gain some enlightenment about their fears and worries.

As for the differences found between otolaryngologists and endocrinologists, Dr. Oltmann speculated that the ear-nose-throat specialists generally see a much broader range of cancers, including some with dismal prognoses.

The Takeaway for Clinicians

The best thing a physician can do after delivering a thyroid cancer diagnosis is to listen, said Dr. Papaleontiou. "For a patient recently diagnosed, sitting in the doctor’s office and hearing the word “cancer” may be one of their biggest fears. It takes time to process and it also takes a bidirectional communication between physician and patient to form a comprehensive understanding of treatment, surveillance, and prognosis, even if the prognosis is good.

"It is important to address that having complex emotions and some distress regarding their diagnosis is normal. I always encourage patients to stay informed about their course of thyroid cancer management. I provide them with information regarding support groups, and I encourage them to seek formal help from a trained professional if they think it may be necessary to address their psychosocial needs regarding their diagnosis."

In prior research, Dr. Papaleontiou has found worry was common in thyroid cancer patients.

For her future research, Dr. Papaleontiou said, she will focus on designing interventions to help physicians understand that calling thyroid cancer ''a good cancer" may not always alleviate worry.

Study co-author Bradley Zebrack, PhD, MPH, MSW, professor of social work at the University of Michigan and a survivor of Hodgkin's lymphoma, would tell individuals newly diagnosed with thyroid cancer who hear their physician call it ''a good cancer'' to ''press the doctor on that," by asking them to explain what they mean.