MON-557 Resource Utilization in the Surveillance of Differentiated Thyroid Cancer: The Impact of Patient Preferences

Introduction: Prior studies have shown an overall increase in surveillance intensity after initial treatment of differentiated thyroid cancer without a clear impact on survival. However, little is known about the role that patient care preferences play in this trend. Methods: Using the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) cancer registries, we identified eligible patients diagnosed with differentiated thyroid cancer (DTC) between 2014-2015. Patients were surveyed by mail and queried on current disease status and healthcare utilization within the last year including physician visits and imaging studies. Patients also completed the validated Medical Maximizer-Minimizer Scale (MMS), which measures stable generalized preferences for seeking more versus less medical care. Patients with recurrent or persistent disease were excluded from the analysis. Ordered logistic regression was performed using a cumulative logit with non-proportional odds. Results: Of the 2,190 patients, 1,707 (77.9%) were female, 1,296 (59.6%) were white, and the median age was 51 years. Using the MMS, 703 respondents (32.8%) were classified as minimizers, 910 (42.4%) were classified as moderate maximizers, and 532 (24.8%) were classified as strong maximizers. In the last year, 173 (24.6%), 244 (27.0%), and 202 (38.4%), respectively, had four or more doctor visits, and 125 (17.8%), 219 (24.2%), and 155 (29.5%) had two or more neck ultrasounds. When controlling for age, sex, race/ethnicity, comorbidity, and AJCC stage, strong medical maximizers as compared with medical minimizers, were significantly more likely to report four or more doctor visits (Odds Ratio (OR) 1.56 (95% Confidence Interval (CI) 1.19-2.04)), two or more neck ultrasounds (OR 1.65 (CI 1.23-2.21)), one or more RAI scans (OR 1.56 (CI 1.08-2.25)), and one or more additional imaging studies (OR 2.09 (CI 1.60-2.74)). Conclusions: Among disease-free differentiated thyroid cancer patients, patient preference for a more maximal versus minimal approach to medical care is associated with increased numbers of physician visits and imaging tests. Given that these additional visits and tests do not clearly correlate with improved outcomes, pose potential risks to patients, and contribute to increased healthcare costs, stronger consideration of patient preferences may be needed when framing discussions on the risks and benefits of surveillance care.