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The usefulness of incorporating near-infrared autofluorescence into the surgical workflow of endocrine surgeons is unclear. Our aim was to develop a prospective registry and gather expert opinion on appropriate use of this technology.This was a prospective multicenter collaborative study of patients undergoing thyroidectomy and parathyroidectomy at 7 academic centers. A questionnaire was disseminated among 24 participating surgeons.Overall, 827 thyroidectomy and parathyroidectomy procedures were entered into registry: 42% of surgeons found near-infrared autofluorescence useful in identifying parathyroid glands before they became apparent; 67% correlated near-infrared autofluorescence pattern to normal and abnormal glands; 38% of surgeons used near-infrared autofluorescence, rather than frozen section, to confirm parathyroid tissue; and 87% and 78% of surgeons reported near-infrared autofluorescence did not improve the success rate after parathyroidectomy or the ability to find ectopic glands, respectively. During thyroidectomy, 66% of surgeons routinely used near-infrared autofluorescence to rule out inadvertent parathyroidectomy. However, only 36% and 45% felt near-infrared autofluorescence decreased inadvertent parathyroidectomy rates and improved ability to preserve parathyroid glands during central neck dissections, respectively.This survey study identified areas of greatest potential use for near-infrared autofluorescence, which can form the basis of future objective trials to document the usefulness of this technology.

ImportanceCounseling prior to thyroid cancer (TC) treatment is an essential component of informed consent. An informed patient affects treatment-related expectations and patient engagement, factors that contribute significantly to patient-reported quality-of-life outcomes.ObjectiveTo describe experiences with pretreatment counseling among survivors of TC and to test factors associated with self-reported treatment meeting expectations.Design, Setting, and ParticipantsA cross-sectional survey was administered between October 18, 2019, and February 8, 2020, to members of ThyCa: Thyroid Cancer Survivors’ Association Inc, and to individuals accessing the public-facing ThyCa website. Survey respondents were asked 55 questions, including 4 free-text questions and 2 multiple-choice questions about pretreatment counseling.Main Outcomes and MeasuresRespondents self-reported (1) their unmet information needs, (2) rates of treatment meeting expectations, and (3) rates of treatment understanding. A mixed-methods analysis was performed, including qualitative content analysis of free-text responses and multivariable logistic regression of factors associated with self-reported levels of treatment meeting expectations.ResultsOf the 1412 survey respondents, 1249 were women (88.4%). The median age at diagnosis was 48 years (range, 18-85 years), and the median age at the time of survey completion was 60 years (range, 18-87 years). A total of 1259 respondents (89.2%) provided free-text responses to the question, “What would you tell someone newly diagnosed with your same condition?” Of these individuals, 526 (37.2%) reported inadequate pretreatment plan understanding and 578 (40.9%) reported that their treatment experience did not meet their expectations. Treatment met expectations for only 95 respondents (18.1%) reporting an inadequate pretreatment plan understanding. Of the 526 survivors of TC reporting a lack of understanding, 473 (90.0%) provided additional textual comments, most commonly in the categories of postoperative treatment, surveillance, and treatment effects. On multivariable logistic regression, self-reported failure to have an understanding of TC treatment was independently associated with failure of treatment to meet expectations (odds ratio, 5.1 [95% CI, 3.7-6.9]). Patients reporting a full understanding of their treatment plan were 5-fold more likely to indicate that their initial treatment experience was on par with expectations, independent of reported postoperative complications, age, sex, and other potential confounders.Conclusions and RelevanceIn this survey study, a substantial proportion of survivors of TC reported inadequate pretreatment understanding. This gap in understanding was associated with high levels of self-reported failure of treatment to meet expectations, which in turn is associated in other studies with poorer patient-reported quality-of-life outcomes. These outcomes may be improved by addressing gaps in patient understanding so expectations more closely match TC diagnosis and treatment pathways.

e18030 Background: Advanced thyroid cancers can invade the recurrent Laryngeal Nerve (RLN) resulting in vocal cord paralysis (VCP). This can significantly impact the surgical strategy given the need to sacrifice the invaded RLN, the potential for bilateral VCP and tracheotomy. Methods: We retrospectively identified patients diagnosed with advanced thyroid carcinomas (of any histology) at 3 high-volume tertiary centers who met the following criteria: treated between 01/2017 and 12/2022, tested for driver/targetable somatic mutations, received targeted neoadjuvant therapy, underwent laryngoscopic exam to assess vocal cords (VC) functional status before, during and after neoadjuvant therapy, and underwent surgery. Results: We identified 6 patients who met the eligibility criteria. Mean age at diagnosis is 69. Five patients were diagnosed with anaplastic thyroid carcinoma, while 1 with papillary thyroid carcinoma. Somatic mutations were detected in BRAFV600E in 6 patients (100%), TERT promoter in 3 (50%) and in PIK3CA & TP53 in 2 patients each (33%). Five patients received dabrafenib/trametinib & 1 patient received lenvatinib. One patient received radiotherapy before neoadjuvant therapy. Baseline laryngoscopic exam detected 5 left-sided VCP and 1 right-sided VCP. After neoadjuvant therapy, 4 patients (67%) regained VC function after 3 months of therapy. By 13.5 months, all patients (100%) regained normal VC function, with a mean time-to-return of VC function of 5 months. The affected RLN could be surgically spared in 5 patients (83%). Conclusions: Use of neoadjuvant targeted therapy resulted in return of VC function in all patients after initially abnormal laryngeal exams, with 67% of patients showing return of function after 3 months. Additionally, neoadjuvant therapy resulted in tumor response sufficient to spare 5 RLNs from surgical resection (83%). Serial laryngoscopic exams during neoadjuvant therapy could guide surgical strategy, impact surgical timing, and provide an additional meaningful treatment outcome. VC function could be used as an endpoint in future neoadjuvant trials. Potential limitations include tertiary center referral bias and selection bias (patients who met eligibility criteria may have favorable trajectory, while patients with aggressive disease who didn’t respond to therapy were excluded). Clinical trials are undergoing to further validate our results. [Table: see text]

Objective To survey a large cohort of thyroid cancer survivors from ThyCa on information needs and expectations of their treatment to better understand the pretreatment counseling, information, and support needs of this population. Methods Anonymous survey of thyroid cancer survivors. Results One thousand one hundred twenty-four patients with thyroid cancer participated in the survey. Three hundred sixty-two (37.44%) reported not having had a full understanding of their treatment plan and 407 (46.41%) reported that their thyroid cancer treatment did not conform to expectations. Patients diagnosed at younger ages were significantly more likely to report inadequate understanding of the treatment, failure of treatment to meet expectations, and call for greater attention to psychological well-being. Older patients were more likely to report unexpected effects on speech and swallowing. Regardless of age, patients most frequently called for greater attention to management of energy levels (endorsed by 61% of respondents), psychological well-being (50%), and weight changes (48%). Conclusions Improvements are needed in age-specific communication of thyroid cancer diagnosis and treatment.

e23054 Background: Tobacco cessation is an acknowledged key component of cancer survivorship programs, but significant barriers to program implementation exist. In a 2012 ASCO member survey, 86% of respondents agreed that tobacco cessation should be a routine part of clinical care. However, only 29% reported adequate training. A 2013 survey of physicians at NCI Cancer Centers also showed high levels of support for such programs, but only 1% of oncologists personally engaged themselves. This view is in line with ASCO guidelines that recommend cessation interventions by primary care (PCPs). There is a disconnect between the oncologist’s desire to provide high quality tobacco cessation support for cancer patients and the delegation and delivery of such support. The goal of our study is to evaluate current tobacco cessation practices of PCPs in a large integrated healthcare system. Methods: An electronic survey was sent to all PCPs (n = 165) of the NorthShore Medical Group (Northern Illinois) with questions about their views and practices regarding tobacco cessation. Results: 53 PCPs responded to the survey (response rate of 32%). 94% of respondents believe that PCPs are primarily responsible for addressing tobacco cessation with general patients. 89% believe that PCPs are also responsible for cancer patients, although 34% believe the responsibility should be shared with oncologists. 100% believe that tobacco use affects cancer outcomes in their patients, and 98% report sufficient training in providing cessation support. 90% always ask their patients about tobacco status at the initial visit; this drops to 21% at follow-up visits. For current smokers, 57% of PCPs recommend tobacco cessation all the time and 36% recommend services most of the time. Lack of patient willingness was the most frequently cited barrier to tobacco cessation efforts (74%), followed by lack of time (46%) and lack of resources (42%). Conclusions: PCPs view themselves as primarily responsible for addressing tobacco cessation with their patients but are limited by multiple factors. This primary care-based approach is endorsed by ASCO and other clinical guidelines. More financial and clinical support should be allocated for successful efforts against tobacco dependency.