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Endocrinology and Metabolism Clinics of... Mar 2019Most low-risk papillary thyroid microcarcinomas are indolent. Ten years of active surveillance at Kuma Hospital revealed that only 8.0% of patients showed enlargement of... (Review)
Review
Most low-risk papillary thyroid microcarcinomas are indolent. Ten years of active surveillance at Kuma Hospital revealed that only 8.0% of patients showed enlargement of 3 mm or greater, whereas only 3.8% showed nodal metastasis. None, including those who underwent rescue surgery after the detection of progression, showed life-threatening recurrence or distant metastasis, and none died of thyroid carcinoma. Adverse events were significantly more frequent in patients who underwent immediate surgery than in those who had active surveillance. Medical costs were significantly higher. Therefore, active surveillance ought to be the primary method of low-risk papillary thyroid microcarcinoma management.
Topics: Carcinoma, Papillary; Humans; Thyroid Neoplasms; Watchful Waiting
PubMed: 30717903
DOI: 10.1016/j.ecl.2018.10.007 -
World Journal of Gastroenterology Jun 2019Hereditary diffuse gastric cancer (HDGC) syndrome is an inherited cancer risk syndrome associated with pathogenic germline variants. Given the high risk for developing... (Review)
Review
Hereditary diffuse gastric cancer (HDGC) syndrome is an inherited cancer risk syndrome associated with pathogenic germline variants. Given the high risk for developing diffuse gastric cancer, carriers are recommended to undergo prophylactic total gastrectomy for cancer risk reduction. Current guidelines recommend upper endoscopy in carriers prior to surgery and then annually for individuals deferring prophylactic total gastrectomy. Management of individuals from HDGC families without pathogenic variants remains less clear, and management of families with pathogenic variants in the absence of a family history of gastric cancer is particularly problematic at present. Despite adherence to surveillance protocols, endoscopic detection of cancer foci in HDGC is suboptimal and imperfect for facilitating decision-making. Alternative endoscopic modalities, such as chromoendoscopy, endoscopic ultrasound, and other non-white light methods have been utilized, but are of limited utility to further improve cancer detection and risk stratification in HDGC. Herein, we review what is known and what remains unclear about endoscopic surveillance for HDGC, among individuals with and without germline pathogenic variants. Ultimately, the use of endoscopy in the management of HDGC remains a challenging arena, but one in which further research to improve surveillance is crucial.
Topics: Antigens, CD; Cadherins; Early Detection of Cancer; Female; Gastrectomy; Gastroscopy; Germ-Line Mutation; Guideline Adherence; Humans; Neoplastic Syndromes, Hereditary; Practice Guidelines as Topic; Prophylactic Surgical Procedures; Stomach; Stomach Neoplasms; Watchful Waiting
PubMed: 31249446
DOI: 10.3748/wjg.v25.i23.2878 -
Medical Decision Making : An... Nov 2019Men with a low-risk prostate cancer (PCa) should consider observation, particularly active surveillance (AS), a monitoring strategy that avoids active treatment (AT) in... (Comparative Study)
Comparative Study
Men with a low-risk prostate cancer (PCa) should consider observation, particularly active surveillance (AS), a monitoring strategy that avoids active treatment (AT) in the absence of disease progression. To determine clinical and decision-making factors predicting treatment selection. Prospective cohort study. Kaiser Permanente Northern California (KPNC). Men newly diagnosed with low-risk PCa between 2012 and 2014 who remained enrolled in KPNC for 12 months following diagnosis. We used surveys and medical record abstractions to measure sociodemographic and clinical characteristics and psychological and decision-making factors. Men were classified as being on observation if they did not undergo AT within 12 months of diagnosis. We performed multivariable logistic regression analyses. The average age of the 1171 subjects was 61.5 years ( = 7.2 years), and 81% were white. Overall, 639 (57%) were managed with observation; in adjusted analyses, significant predictors of observation included awareness of low-risk status (odds ratio 1.75; 95% confidence interval 1.04-2.94), knowing that observation was an option (3.62; 1.62-8.09), having concerns about treatment-related quality of life (1.21, 1.09-1.34), reporting a urologist recommendation for observation (8.20; 4.68-14.4), and having a lower clinical stage (T1c v. T2a, 2.11; 1.16-3.84). Conversely, valuing cancer control (1.54; 1.37-1.72) and greater decisional certainty (1.66; 1.18-2.35) were predictive of AT. Results may be less generalizable to other types of health care systems and to more diverse populations. Many participants selected observation, and this was associated with tumor characteristics. However, nonclinical decisional factors also independently predicted treatment selection. Efforts to provide early decision support, particularly targeting knowledge deficits, and reassurance to men with low-risk cancers may facilitate better decision making and increase uptake of observation, particularly AS.
Topics: Aged; California; Decision Making; Disease Progression; Humans; Male; Middle Aged; Prospective Studies; Prostatic Neoplasms; Quality of Life; Risk; Surveys and Questionnaires; Watchful Waiting
PubMed: 31631745
DOI: 10.1177/0272989X19883242 -
Fertility and Sterility Mar 2022
Topics: Female; Fertility Agents, Female; Humans; Infertility; Watchful Waiting
PubMed: 35105442
DOI: 10.1016/j.fertnstert.2021.12.033 -
Digestive Surgery 2019Active surveillance after neoadjuvant therapies has emerged among several malignancies. During active surveillance, frequent assessments are performed to detect residual... (Review)
Review
BACKGROUND
Active surveillance after neoadjuvant therapies has emerged among several malignancies. During active surveillance, frequent assessments are performed to detect residual disease and surgery is only reserved for those patients in whom residual disease is proven or highly suspected without distant metastases. After neoadjuvant chemoradiotherapy (nCRT), nearly one-third of esophageal cancer patients achieve a pathologically complete response (pCR). Both patients that achieve a pCR and patients that harbor subclinical disseminated disease after nCRT could benefit from an active surveillance strategy.
SUMMARY
Esophagectomy is still the cornerstone of treatment in patients with esophageal cancer. Non-surgical treatment via definitive chemoradiotherapy (dCRT) is currently reserved only for patients not eligible for esophagectomy. Since salvage esophagectomy after dCRT (50-60 Gy) results in increased complications, morbidity and mortality compared to surgery after nCRT (41.4 Gy), the latter seems preferable in the setting of active surveillance. Clinical response evaluations can detect substantial (i.e., tumor regression grade [TRG] 3-4) tumors after nCRT with a sensitivity of 90%, minimizing the risk of development of non-resectable recurrences. Current scarce and retrospective literature suggests that active surveillance following nCRT might not jeopardize overall survival and postponed surgery could be performed safely. Key Message: Before an active surveillance approach could be considered standard treatment, results of phase III randomized trials should be awaited.
Topics: Chemoradiotherapy; Esophageal Neoplasms; Esophagectomy; Humans; Neoadjuvant Therapy; Organ Sparing Treatments; Watchful Waiting
PubMed: 30227434
DOI: 10.1159/000493435 -
Frontiers in Endocrinology 2023Currently, the differentiated thyroid cancer (DTC) management is shifted toward a tailored approach based on the estimated risks of recurrence and disease-specific... (Review)
Review
Currently, the differentiated thyroid cancer (DTC) management is shifted toward a tailored approach based on the estimated risks of recurrence and disease-specific mortality. While the current recommendations on the management of metastatic and progressive DTC are clear and unambiguous, the management of slowly progressive or indeterminate disease varies according to different centers and different physicians. In this context, active surveillance (AS) becomes the main tool for clinicians, allowing them to plan a personalized therapeutic strategy, based on the risk of an unfavorable prognosis, and to avoid unnecessary treatment. This review analyzes the main possible scenarios in treated DTC patients who could take advantage of AS.
Topics: Humans; Watchful Waiting; Iodine Radioisotopes; Thyroid Neoplasms; Adenocarcinoma; Prognosis
PubMed: 37152950
DOI: 10.3389/fendo.2023.1133958 -
Hormone Research in Paediatrics 2020
Topics: Adrenarche; Breast; Female; Humans; Male; Puberty, Precocious; Unnecessary Procedures; Watchful Waiting
PubMed: 33352558
DOI: 10.1159/000512764 -
European Journal of Cancer Care Nov 2022The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting.
METHOD
Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted.
RESULTS
A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting.
CONCLUSION
Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions.
Topics: Adult; Humans; Depression; Watchful Waiting; Anxiety; Neoplasms; Hematology
PubMed: 35977801
DOI: 10.1111/ecc.13678 -
American Journal of Respiratory and... Nov 2020
Topics: Critical Care; Humans; Intensive Care Units; Patient Discharge; Resource Allocation; Watchful Waiting
PubMed: 32755485
DOI: 10.1164/rccm.202007-2873ED -
American Journal of Surgery Jul 2021The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing...
BACKGROUND
The 2015 American Thyroid Association endorsed less aggressive management for low-risk papillary thyroid cancer (LR-PTC). We aimed to identify factors influencing physicians' recommendations for LR-PTC.
METHODS
We surveyed members of three professional societies and assessed respondents' recommendations for managing LR-PTC using patient scenarios. Multivariable logistic regression models identified clinical and non-clinical factors associated with recommending total thyroidectomy (TT) and active surveillance (AS).
RESULTS
The 345 respondents included 246 surgeons and 99 endocrinologists. Physicians' preference for their own management if diagnosed with LR-PTC had the strongest association with their recommendation for TT and AS (TT: OR 12.3; AS: OR 7.5, p < 0.001). Physician specialty and stated patient preference were also significantly associated with their recommendations for both management options. Respondents who received information about AS had increased odds of recommending AS.
CONCLUSIONS
Physicians' recommendations for LR-PTC are strongly influenced by non-clinical factors, such as personal treatment preference and specialty.
Topics: Adult; Age Factors; Aged; Clinical Decision-Making; Comorbidity; Endocrinologists; Female; Humans; Male; Medical Overuse; Middle Aged; Patient Preference; Practice Patterns, Physicians'; Risk Assessment; Surgeons; Surveys and Questionnaires; Thyroid Cancer, Papillary; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Tumor Burden; United States; Watchful Waiting; Young Adult
PubMed: 33248684
DOI: 10.1016/j.amjsurg.2020.11.021