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Disparities in risk perception of thyroid cancer recurrence and death
Author(s) -
Chen Debbie W.,
ReyesGastelum David,
Wallner Lauren P.,
Papaleontiou Maria,
Hamilton Ann S.,
Ward Kevin C.,
Hawley Sarah T.,
ZikmundFisher Brian J.,
Haymart Megan R.
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32670
Subject(s) - medicine , worry , odds ratio , epidemiology , demography , logistic regression , thyroid cancer , disease , confidence interval , cancer , psychiatry , anxiety , sociology
Background To the authors' knowledge, studies regarding risk perception among survivors of thyroid cancer are scarce. Methods The authors surveyed patients who were diagnosed with differentiated thyroid cancer from the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles County (2632 patients; 63% response rate). The analytic cohort was defined by a ≤5% risk of disease recurrence and mortality (1597 patients). Patients estimated their recurrence and mortality risks separately (increments of 10% and endpoints of ≤5% and ≥95%). Both outcomes were dichotomized between reasonably accurate estimates (risk perception of ≤5% or 10%) versus overestimation (risk perception of ≥20%). Multivariable logistic regression was used to identify factors associated with risk overestimation, and the relationships between overestimation and both worry and quality of life were evaluated. Results In the current study sample, 24.7% of patients overestimated their recurrence risk and 12.5% overestimated their mortality risk. A lower educational level was associated with overestimating disease recurrence (≤high school diploma: odds ratio [OR], 1.64 [95% CI, 1.16‐2.31]; and some college: OR, 1.36 [95% CI, 1.02‐1.81]) and mortality (≤high school diploma: OR, 1.86 [95% CI, 1.18‐2.93]) risk compared with those attaining at least a college degree. Hispanic ethnicity was found to be associated with overestimating recurrence risk (OR, 1.44, 95% CI 1.02‐2.03) compared with their white counterparts. Worry about recurrence and death was found to be greater among patients who overestimated versus those who had a reasonably accurate estimate of their risk of disease recurrence and mortality, respectively ( P < .001). Patients who overestimated mortality risk also reported a decreased physical quality of life (mean T score, 43.1; 95% CI, 41.6‐44.7) compared with the general population. Conclusions Less educated patients and Hispanic patients were more likely to report inaccurate risk perceptions, which were associated with worry and a decreased quality of life.