Medullary Thyroid Cancer: Are Practice Patterns in the United States Discordant From American Thyroid Association Guidelines?
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Surgery is the mainstay of treatment for medullary thyroid cancer (MTC), with long-term patient outcomes associated with adequacy of resection. This study benchmarked national practice patterns against 2009 American Thyroid Association (ATA) guidelines for MTC regarding use of thyroidectomy, lymphadenectomy, radioactive iodine (RAI), and external-beam radiotherapy (EBRT).
This is a cross-sectional, retrospective cohort study of MTC patients in the Surveillance, Epidemiology, and End Results Program database, 1973 to 2006. ATA recommendations 61 to 66 (extent of surgery), 85 (RAI), and 93 (EBRT) were analyzed. Outcome of interest was practice accordance with these recommendations. Predictors of accordance were determined and Kaplan–Meier survival analyses were performed.
A total of 2033 patients with MTC were identified. Fifty-nine percent were women; 78% were white. Forty-one percent of patients did not receive appropriate surgical therapy (recommendations 61 to 63). Most patients with distant metastatic disease had less aggressive surgery and more EBRT (P < 0.001) (recommendations 64 to 66). Four percent of patients received inappropriate RAI (recommendation 85). Two hundred nine patients had gross incomplete resections, with 33% receiving postoperative EBRT (recommendation 93). Statistically significant predictors of receiving surgery discordant with ATA recommendations in multivariate analysis were patient age >65, female sex, earlier year of diagnosis (1988 to 1997), geographic region, intrathyroidal tumor extent, and tumor size of ≤1 cm. Patients receiving surgery discordant with recommendations had shorter survival than those receiving surgery according to recommendations (P < 0.05).
Variation in practice patterns exist in the United States with regard to extent of surgery and lymphadenectomy for MTC. Dissemination of standardized guidelines is important to ensure optimal treatment with less variation in quality of care.
- American Cancer Society (2009). Cancer facts and figures. Available at: http://www.cancer.org. Accessed October 2009.
- Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer. 2000;88:1139–48. CrossRef
- Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases. Cancer. 2006;107:2134–42. CrossRef
- You YN, Lakhani V, Wells SA Jr, Moley JF. Medullary thyroid cancer. Surg Oncol Clin N Am. 2006;15:639–60. CrossRef
- Faik Erdogan M, Gursoy A, Erdogan G, Kamel N. Radioactive iodine treatment in medullary thyroid carcinoma. Nucl Med Commun. 2006;27:359–62. CrossRef
- Schlumberger M, Abdelmoumene N, Delisle MJ, Couette JE. Treatment of advanced medullary thyroid cancer with an alternating combination of 5 FU-streptozocin and 5 FU-dacarbazine. The Groupe d’Etude des Tumeurs a Calcitonine (GETC). Br J Cancer. 1995;71:363–5.
- Nocera M, Baudin E, Pellegriti G, et al. Treatment of advanced medullary thyroid cancer with an alternating combination of doxorubicin-streptozocin and 5 FU-dacarbazine. groupe d’etude des tumeurs a calcitonine (GETC). Br J Cancer. 2000;83:715–8. CrossRef
- Schwartz DL, Rana V, Shaw S, et al. Postoperative radiotherapy for advanced medullary thyroid cancer—local disease control in the modern era. Head Neck. 2008;30:883–8. CrossRef
- Weisz G, Cambrosio A, Keating P, et al. The emergence of clinical practice guidelines. Milbank Q. 2007;85:691–727.
- Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:109–42. CrossRef
- American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214. CrossRef
- British Thyroid Association. Guidelines for the management of thyroid cancer. 2007. Available at: http://www.british-thyroid-association.org/Guidelines/. Accessed August 2009.
- Al-Rawi M, Wheeler MH. Medullary thyroid carcinoma—update and present management controversies. Ann R Coll Surg Engl. 2006;88:433–8. CrossRef
- National Comprehensive Cancer Network. Clinical practice guidelines for medullary thyroid carcinoma. 2009. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed August 2009.
- Gharib H, Papini E, Valcavi R, et al. American association of clinical endocrinologists and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63–102.
- American Head and Neck Society. Guidelines for medullary thyroid carcinoma. 1995. Available at: http://www.ahns.info/clinicalresources/guidelines.php. Accessed November 2009.
- American Thyroid Association Guidelines Task Force, Kloos RT, Eng C, Evans DB, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid. 2009;19:565–612. CrossRef
- Miyauchi A, Matsuzuka F, Hirai K, et al. Unilateral surgery supported by germline RET oncogene mutation analysis in patients with sporadic medullary thyroid carcinoma. World J Surg. 2000;24:1367–72. CrossRef
- Miyauchi A, Matsuzuka F, Hirai K, et al. Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World J Surg. 2002;26:1023–8. CrossRef
- Ito Y, Miyauchi A, Yabuta T, et al. Alternative surgical strategies and favorable outcomes in patients with medullary thyroid carcinoma in Japan: experience of a single institution. World J Surg. 200;33:58–66.
- National Cancer Institute D, Surveillance Research Program, Cancer Statistics Branch. Available at: http://seer.cancer.gov/registries/. Accessed August 2009.
- National Cancer Institute D, Surveillance Research Program, Cancer Statistics Branch. Available at: http://seer.cancer.gov/about/. Accessed August 2009.
- Wang TS, Roman SA, Cox H, Air M, Sosa JA. The management of thyroid nodules in patients with primary hyperparathyroidism. J Surg Res. 2009;154:317–23. CrossRef
- Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342(8883):1317–22. CrossRef
- Worrall G, Chaulk P, Freake D. The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review. CMAJ. 1997;156:1705–12.
- Famakinwa O, Roman SA, Wang TS, Sosa JA. ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States? Am J Surg. 2010;199:189–98. CrossRef
- Ahern CH, Shen Y. Cost-effectiveness analysis of mammography and clinical breast examination strategies: a comparison with current guidelines. Cancer Epidemiol Biomarkers Prev. 2009;18:718–25. CrossRef
- US Preventive Services Task Force. Screening for breast cancer: US preventive services task force recommendation statement. Ann Intern Med. 2009;151:716–26.
- Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283:2579–84. CrossRef
- Sosa JA, Bowman HM, Tielsch JM, et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228:320–30. CrossRef
- Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA. A population-based study of outcomes from thyroidectomy in aging americans: at what cost? J Am Coll Surg. 2008;206:1097–105. CrossRef
- Sosa JA, Mehta PJ, Wang TS, Yeo HL, Roman SA. Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg. 2007;246:1083–91. CrossRef
- Tehranifar P, Neugut AI, Phelan JC, et al. Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomarkers Prev. 2009;18:2701–8.
- Lillie-Blanton M, Maleque S, Miller W. Reducing racial, ethnic, and socioeconomic disparities in health care: opportunities in national health reform. J Law Med Ethics. 2008;36:693, 702, 608.
- Lundgren CI, Delbridge L, Learoyd D, Robinson B. Surgical approach to medullary thyroid cancer. Arq Bras Endocrinol Metab. 2007;51:818–24.
- Herbert MA, Prince SL, Williams JL, Magee MJ, Mack MJ. Are unaudited records from an outcomes registry database accurate? Ann Thorac Surg. 2004;77:1960, 4.
- American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology–Head and Neck Surgery, American Head and Neck Society, Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153–8. CrossRef
- Medullary Thyroid Cancer: Are Practice Patterns in the United States Discordant From American Thyroid Association Guidelines?
Annals of Surgical Oncology
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