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. 2013 May;98(5):2001-8.
doi: 10.1210/jc.2012-3355. Epub 2013 Mar 28.

Variation in the management of thyroid cancer

Megan R Haymart  1 , Mousumi Banerjee, Di Yang, Andrew K Stewart, James C Sisson, Ronald J Koenig, Gerard M Doherty, Jennifer J Griggs
Affiliations

Variation in the management of thyroid cancer

Megan R Haymart et al. J Clin Endocrinol Metab. 2013 May.

Abstract

Context: Little is known about practice patterns in thyroid cancer, a cancer that is increasing in incidence.

Objective: We sought to identify aspects of thyroid cancer management that have the greatest variation.

Design/setting/participants: We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the US National Cancer Database. Physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement postsurgery, and long-term thyroid cancer management. We calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater variation.

Results: We had a 66% response rate. We found variation in multiple aspects of thyroid cancer management, including the role of central lymph node dissections (variation, 0.99; 95% confidence interval [CI], 0.98-1.00), the role of pretreatment scans before radioactive iodine treatment (variation, 1.00; 95% CI, 0.98-1.00), and all aspects of long-term thyroid cancer management, including applications of ultrasound (variation, 0.97; 95% CI, 0.93-0.99) and radioactive iodine scans (variation, 0.99; 95% CI, 0.97-1.00). For the management of small thyroid cancers, variation exists in all domains, including optimal extent of surgery (variation, 0.91; 95% CI, 0.88-0.94) and the role of both radioactive iodine treatment (variation, 0.91; 95% CI, 0.89-0.93) and suppressive doses of thyroid hormone replacement (variation, 1.00; 95% CI, 0.99-1.00).

Conclusion: We identified areas of variation in thyroid cancer management. To reduce the variation and improve the management of thyroid cancer, there is a need for more research and more research dissemination.

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Figures

Figure 1.
Figure 1.
Sampling method and subject flow.
Figure 2.
Figure 2.
The observed-to-maximum variation ratios for aspects of thyroid cancer management within the four specified domains: thyroid surgery, radioactive iodine use (RAI), thyroid hormone replacement postsurgery, and long-term thyroid cancer management. CLN, central lymph node; LN, lymph node.
Figure 2.
Figure 2.
The observed-to-maximum variation ratios for aspects of thyroid cancer management within the four specified domains: thyroid surgery, radioactive iodine use (RAI), thyroid hormone replacement postsurgery, and long-term thyroid cancer management. CLN, central lymph node; LN, lymph node.
See this image and copyright information in PMC

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