Lack of Choice Perceived Among Those Treated With RAI for Differentiated Thyroid Cancer

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A majority of respondents (57%) reported feeling that they did not have a choice to not receive RAI.
A majority of respondents (57%) reported feeling that they did not have a choice to not receive RAI.

Typically the use of radioactive iodine (RAI) does not improve the survival or reduce the risk of cancer recurrence in patients with differentiated thyroid cancer (DTC). Yet, many patients continue to receive RAI. In a study presented at the 2018 American Society of Clinical Oncology (ASCO) Quality Care Symposium, researchers at the University of Michigan conclude that many patients did not feel they had a choice in whether to receive RAI treatment.

The researchers surveyed patient with thyroid cancer from 2014 to 2105 from the Georgia and Los Angeles SEER registries. Patients with intermediate-risk thyroid cancer where selective RAI was recommended were also included in the survey. Patients were ask if they felt they had a choice to receive RAI, how strongly their physician recommended initial RAI treatment, and how satisfied they were with their decision to receive RAI.

The majority of respondents (57%) reported feeling that they did not have a choice to not receive RAI, and thus the majority of patients (76%) underwent the therapy. Many patients in whom selective RAI use is recommended, particularly those of more vulnerable groups, did not feel they had a choice about whether or not to receive RAI,” noted the authors. Hispanic and Asian patients were more likely to report a feeling of not having a choice. Furthermore, the feeling of no choice was greater for patients whose doctors strongly recommended the treatment.

Patients who perceived they did not have a choice were also more likely to be dissatisfied with their choice to receive RAI. The authors note that altogether this suggests “a need for more shared treatment decision making to reduce overtreatment.


Wallner LP, Reyes-Gastelum D, Hamilton AS, Ward KC, Hawley ST, Haymart MR. Choice of radioactive iodine treatment for thyroid cancer: Results from a population-based survey. Oral presentation at: 2018 ASCO Quality care Symposium; September 28-29, 2018; Phoenix, AZ. Abstract 159.

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