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Article

Decision-making in Surgery or Active Surveillance for Low Risk Papillary Thyroid Cancer During the COVID-19 Pandemic

1
Division of Endocrinology, University Health Network and University of Toronto, Toronto, ON M5G 2C4, Canada
2
Joint Department of Medical Imaging, University Health Network-Mt Sinai Hospital-Women’s College Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada
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Research Associate, Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, ON M5G 2C4, Canada
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Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, ON M5G 2C4, Canada
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Centre for Health Economics and Policy Analysis, Department of Health Research Methods, Evaluation and Implementation, McMaster University, Hamilton, ON L8S 4L8, Canada
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Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
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Princess Margaret Cancer Centre, Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network and University of Toronto, Toronto, ON M5G 2C4, Canada
*
Author to whom correspondence should be addressed.
Membership of the Canadian Thyroid Cancer Active Surveillance Study Group Investigators is provided in the Acknowledgments.
Cancers 2021, 13(3), 371; https://doi.org/10.3390/cancers13030371
Received: 12 December 2020 / Revised: 13 January 2021 / Accepted: 18 January 2021 / Published: 20 January 2021
(This article belongs to the Special Issue 2020 Update on the Management of Thyroid Cancer)
In March of 2020, the World Health Organization declared a COVID-19 pandemic, which had dramatic implications for thyroid cancer clinical care and research. Beginning early in the pandemic, at the University Health Network in Toronto, cancer care rapidly transitioned from in-person to virtual outpatient cancer care. Elective surgeries were also restricted, particularly for low risk malignancies. We herein discuss our experience conducting an ongoing study on decision-making regarding surgery or active surveillance for small, low risk papillary thyroid cancer (PTC) during the COVID-19 pandemic. Our study protocol was adapted due to safety considerations, including adopting virtual telephone/video teleconferencing patient visits and verbal consent procedures, and allowing for increased flexibility in appointment scheduling. We discuss some preliminary observations on our study process and outcomes during the pandemic.
We describe our experience conducting a prospective observational cohort study on the management of small, low risk papillary thyroid cancer during the COVID-19 pandemic. Our study participants are given the choice of active surveillance (AS) or surgery, and those in the AS arm are followed at the study center, whereas surgical patients undergo usual care. During the pandemic we have transitioned from in-person research patient visits to largely virtual care of patients under AS. As of 30 October 2020, we had enrolled 181 patients enrolled in our study (including 25 during the pandemic), of which 92.3% (167/181) consented to telephone communication and 79.0% (143/181) consented to secure videoconferencing communication. Prior to the pandemic, 74.5% (117/157) of our patients chose AS over surgery, whereas during the pandemic, 96.0% (24/25) chose AS. Of the 133 study patients who were under AS within the timeframe from 12 March 2020, to 30 October 2020, the percentage of patients who missed appointments was 8.3% (11/133, for neck ultrasound and physician visits, respectively) and delayed appointments was 23.3% (31/133). This preliminary data suggests that prospective observational research on AS of thyroid cancer can safely continue during the pandemic. View Full-Text
Keywords: papillary thyroid cancer 1; active surveillance 2; COVID-19 pandemic 3; SARS-CoV-2 4; virtual care 5 papillary thyroid cancer 1; active surveillance 2; COVID-19 pandemic 3; SARS-CoV-2 4; virtual care 5
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MDPI and ACS Style

Sawka, A.M.; Ghai, S.; Ihekire, O.; Jones, J.M.; Gafni, A.; Baxter, N.N.; Goldstein, D.P.; on behalf of the Canadian Thyroid Cancer Active Surveillance Study Group. Decision-making in Surgery or Active Surveillance for Low Risk Papillary Thyroid Cancer During the COVID-19 Pandemic. Cancers 2021, 13, 371. https://doi.org/10.3390/cancers13030371

AMA Style

Sawka AM, Ghai S, Ihekire O, Jones JM, Gafni A, Baxter NN, Goldstein DP, on behalf of the Canadian Thyroid Cancer Active Surveillance Study Group. Decision-making in Surgery or Active Surveillance for Low Risk Papillary Thyroid Cancer During the COVID-19 Pandemic. Cancers. 2021; 13(3):371. https://doi.org/10.3390/cancers13030371

Chicago/Turabian Style

Sawka, Anna M., Sangeet Ghai, Ogemdi Ihekire, Jennifer M. Jones, Amiram Gafni, Nancy N. Baxter, David P. Goldstein, and on behalf of the Canadian Thyroid Cancer Active Surveillance Study Group. 2021. "Decision-making in Surgery or Active Surveillance for Low Risk Papillary Thyroid Cancer During the COVID-19 Pandemic" Cancers 13, no. 3: 371. https://doi.org/10.3390/cancers13030371

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