Dr Christine O'Neill, head of general surgery at Newcastle’s John Hunter Hospital and VMO General and Endocrine Surgeon specialising in treating thyroid cancer, is committed to enhancing patient autonomy and optimising psychosocial care outcomes for thyroid cancer patients.
In Australia, thyroid cancer ranks as the ninth most common cancer, with approximately 4000 new diagnoses every year. The issue of 'overdiagnosis’ – where the cancer found would be unlikely to have produced symptoms or led to serious outcomes if undiscovered - is also significant. Frequently, thyroid cancer is detected incidentally in patients who are having scans for unrelated reasons, which leads to unnecessary stress and treatments.
'While thyroid cancer patients fare well physically, evidence shows that they can struggle psychological and socially.’ Dr O'Neill explains, ‘It is critical to understand the broader implications of thyroid cancer survivorship to optimise patient well-being.’
Dr O’Neill’s interest in the holistic quality of life outcomes for thyroid cancer patients was sparked when attending a surgeon’s conference in 2018. An international speaker presented data revealing that, despite a good survival rate, thyroid cancer patients experienced worse psychological outcomes compared to those with breast, brain or bowel cancer. This inspired Dr O’Neill’s focus on the long-term wellbeing of thyroid cancer survivors.
Dr O’Neill notes that there is a paucity of evidence-based information to support treatment decisions in thyroid cancer and emphasises the need for more resources to guide patients and clinicians in making informed treatment decisions. This aligns with a recent shift in international guidelines towards less invasive treatments for thyroid cancers. This includes moving away from the traditional approach of removing the entire thyroid toward treatments options that are less invasive, such as removing half the thyroid, medication or even opting for no surgery.
To address these current patient-centred gaps, Dr O’Neill and her colleagues are conducting a research project centred on empowering patients and clinicians to collaboratively make treatment decisions for low-risk thyroid cancer. Initial phases of this project have worked with thyroid cancer survivors and specialist clinician groups to understand the experiences and priorities of thyroid cancer survivors, focusing on their specific needs for supportive care.
As a result, the team has developed an hybrid paper and online decision aid to support shared patient-clinician decision-making which aims to reduce decisional regret and enhance health-related quality of life. The major management decision for low-risk thyroid cancer is the extent of surgery. Dr O’Neill believes that patients should be empowered to make individual, values-based surgical decisions.
Support from the NSW Regional Cancer Research Network (NSWRCRN) research grant will ready the decision-making tool for further testing with patients and clinicians. The plan includes iterative refinement before a nationwide implementation trial, with a specific focus on understanding the unique needs of rural/regional communities. The project involves collaboration with national and international groups, capturing diverse patient opinions, including those from regional communities.
The NSW Regional Cancer Research Network is funded by the Cancer Institute NSW through a Translational Cancer Research Capacity Building Grant and established through NSW Regional Health Partners.