Practice patterns in the management of patients with differentiated thyroid cancer in Ontario Canada 2000-2008

Journal of Otolaryngology-Head & Neck Surgery

David R Urbach⁴  Patti A Groome²  Jonathan C Irish¹  Stephen F Hall³ 

[1] Department of Otolaryngology, Wharton Head & Neck Centre, University Health Network, Princess Margaret Hospital, 610 University Ave., Toronto M5G 2 M9, ON, Canada;Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, 10 Stuart St, Kingston, ON, Canada;Departments of Otolaryngology and Oncology, Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Queen’s University, 10 Stuart St. 613 533 6000 ext 78535, Kingston K7L 3 N6, ON, Canada;Division of General Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth St, Toronto M5G 2C4, ON, Canada

关键词: Radioactive iodine 131;    Surgery;    Patterns of practice;    Population-based study;    Thyroid cancer;   

Others  :  1144004
DOI  :  10.1186/s40463-014-0029-3

 received in 2014-02-21, accepted in 2014-07-05,  发布年份 2014

【 摘 要 】

Background

The extent of treatment for differentiated thyroid cancer remains controversial. The objective of this study was to describe the variations in practice prior to diagnosis and for the first year after diagnosis, including the investigations, the extent of surgery and the use of RAI 131, for all patients with thyroid cancer (TC) treated Jan 1 2000 to Dec 2008 across Ontario Canada.

Method

Population-based study of all patients who had a therapeutic surgical procedure for TC based on the data holdings of the Institute of Clinical Investigative Sciences (ICES) linking the Ontario Cancer Registry to the Ontario Health Insurance Plan and to the Canadian Institutes of Health Information. The analysis includes comparisons between health care utilization/geographic regions and between treating specialties. The study population was 12957 patients.

Results

There was a 112% increase in case detection over 9 years. Overall the initial (index) surgery was less-than-total thyroidectomy (LTT) in 37.6% and 63.4% of the patients who had total thyroidectomy (TT) as an index surgery went on to adjuvant RAI, however there was wide variation in all aspects of patient care across the province, between Local Health Networks and between surgical specialties.

Conclusion

In Ontario, there was wide variation for most aspects of the management of TC and, as the incidence of TC is increasing at least 7% per year in females, these data provide a foundation for future discussions, the provision of health care services and research.

【 授权许可】

   
2014 Hall et al.

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【 参考文献 】

• [1]Wennberg J: The Paradox of Appropriate Care. JAMA 1987, 258:2568-2569.
• [2]Eddy D: Variations in physician practice: the role of uncertainty. Health Affairs 1984, 3:74-89.
• [3]McLeod D, Sawka A, Cooper D: Controversies the primary treatment of low-risk papillary thyroid cancer. Lancet 2013, 381:1046-1057.
• [4]Sawka A, Brierley J, Ezzat S, Goldstein D: Managing newly diagnosed thyroid cancer. CMAJ 2014, 186:269-275.
• [5]Hall SF, Irish JC, Groome P, Griffiths R: Access, Excess and Overdiagnosis: the case for thyroid cancer. Cancer Med 2013, 184:1-8. doi:10.1002/cam/4
• [6]Urbach D, Simunovic M, Schultz S: Cancer Surgery in Ontario: ICES Atlas. Institute of Clinical Evaluative Sciences, Toronto; 2008.
• [7]Iron K, Goel V, Williams J: Concordance With Hospital Discharge Abstracts And Physicians Claims For Surgical Procedures in Ontario (ICES Working Paper Series Report #42). Institute for Clinical Evaluative Sciences, North York (Ontario); 1995.
• [8]Wu A, Wang M, Nguyen C: Surgical Practice Patterns in he treatment of papillary thyroid microcarcinoma. Arch Otolaryngol Head Neck Surg 2010, 136:1182-1190.
• [9]Sawka A, Rotstein L, Tsang RW BJ, Thabane L, Gafni A, Straus S, Kamalanathan S, Zhao B, Goldstein DP, Rambaldini G, Ezzat S: Regional differences in opinions on adjuvant radioactive iodine treatment of thyroid carcinoma with Canada and the United States. Thyroid 2007, 17:1235-1242.
• [10]Van den Bruel A, Moreno-Reuest R, Bex M, Daumerie C, Glinoer D: Is the management of thyroid nodules and differentiated thyroid cancer in accordance with recent consensus guidelines? Clin Endo 2008, 68:599-604.
• [11]Parks N, Taylor M, Trites J, Hart R: Management of Goitre and small nodule disease by Canadian Otolaryngologists. J Otolaryngology-Head and Neck Surgery 2012, 41:240-245.
• [12]Haymart M, Banerjee M, Stewart A, Koenig R, Birkmeyer J, Griggs J: Use of Radioactive Iodine for Thyroid Cancer. JAMA 2011, 306:721-728.
• [13]Panigrahi B, Roman S: Medullary thyroid cancer: are practice patterns in the United Sates discordance from ATA Guidelines? Ann Surg Oncol 2010, 17:1490-1498.
• [14]Hall S, Groome P, Irish J, O’Sullivan B: Radiotherapy or Surgery for cancer of the hypopharynx: establishing the baseline. Cancer 2010, 115:5711-5722.
• [15]Groome PA, O’Sullivan B: Glottic Cancer in Ontario Canada and the SEER areas of the United States: Do different management philosophies produce different outcome profiles? J Clin Epidemiol 2001, 54:301-315.
• [16]Groome P, O'Sullivan B, Irish J, Rothwell DM, Schulze K, Warde PR, Schneider KM, Mackenzie RG, Hodson DI, Hammond JA, Gulavita SP, Eapen LJ, Dixon PF, Bissett RJ, Mackillop WJ: Management and outcome differences in supraglottic cancer between Ontario Canada and the SEER areas of the United States. J Clin Oncol 2002, 21:496-505.
• [17]Hall S, Walker H, Seimens R, Schneeberg A: increasing detection or increasing incidence in thyroid cancer. World J Surg 2009, 33:2567-2571.
• [18]Welch G, Black W: Overdiagnosis in Cancer. J Natl Cancer Inst 2010, 102:605-613.
• [19]Chassin MR: Explaining geographic variations: the Enthusiasm Hypothesis. Med Care 1993, 31:YS37-YS44.
• [20]Park R, Fink A, Brook R, Chassin MR, Kahn KL, Merrick NJ, Kosecoff J, Solomon DH: Physician ratings of appropriate indications for six medical and surgical procedures. Am J Pub Health 1986, 76:766-769.