Disparities in risk perception of thyroid cancer recurrence and death.

Chen DW, Reyes-Gastelum D, Wallner LP, Papaleontiou M, Hamilton AS, Ward KC, Hawley ST, Zikmund-Fisher BJ, Haymart MR. Disparities in risk perception of thyroid cancer recurrence and death. Cancer. 2020 Apr 1; 126(7):1512-1521.

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Abstract:

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.