title: Factors that influence radioactive iodine use for thyroid cancer.
abstract: BACKGROUND
  There is variation in the use of radioactive iodine (RAI) as treatment for well-differentiated thyroid cancer. The factors involved in physician decision-making for RAI remain unknown.
  
  
  METHODS
  We surveyed physicians involved in postsurgical management of patients with thyroid cancer from 251 hospitals. Respondents were asked to rate the factors important in influencing whether a thyroid cancer patient receives RAI. Multivariable analyses controlling for physician age, gender, specialty, case volume, and whether they personally administer RAI, were performed to determine correlates of importance placed on patients' and physicians' worry about death from cancer and differences between low- versus higher-case-volume physicians.
  
  
  RESULTS
  The survey response rate was 63% (534/853). Extent of disease, adequacy of surgical resection, patients' willingness to receive RAI, and patients' age were the factors physicians were most likely to report as quite or very important in influencing recommendations for RAI to patients with thyroid cancer. Interestingly, both physicians' and patients' worry about death from thyroid cancer were also important in determining RAI use. Physicians with less thyroid cancer cases per year were more likely than higher-volume physicians to report patients' (p<0.001) and physicians' worry about death (p=0.016) as quite or very important in decision-making. Other factors more likely to be of greater importance in determining RAI use for physicians with lower thyroid cancer patient volume versus higher include the accepted standard at the affiliated hospital (p=0.020), beliefs about RAI expressed by colleagues comanaging patients (p=0.003), and patient distance from the nearest facility administering RAI (p=0.012).
  
  
  CONCLUSIONS
  In addition to the extent of disease and adequacy of surgical resection, physicians place importance on physician and patient worry about death from thyroid cancer when deciding whether to treat a patient with RAI. The factors important to physician decision-making differ based on physician thyroid-cancer case-volume, with worry about death being more influential for low-case-volume physicians. As the mortality from thyroid cancer is low, the importance placed on death in decision making may be unwarranted.
authors.affiliation: Division of Metabolism, Endocrinology, and Diabetes, Department of Medicine, University of Michigan Health System, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Papaleontiou
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Di
authors.initials: D
authors.lastname: Yang
authors.forename: James C
authors.initials: JC
authors.lastname: Sisson
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Koenig
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010818:Practice Patterns, Physicians'; D013964:Thyroid Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D014481:United States / Q000453:epidemiology
chemical_list: D007457:Iodine Radioisotopes