Disparity in the use of adjuvant radioactive iodine ablation among high-risk papillary thyroid cancer patients |
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| Affiliation: | 1. Temple University Hospital, Department of Surgery, 3401 N Broad St, Philadelphia, PA, 19140, United States;2. Lewis Katz School of Medicine at Temple University, Department of Clinical Sciences, 3500 N Broad St, Philadelphia, PA, 19140, United States;3. Thomas Jefferson University, Department of Radiology, 1100 Walnut Street, Philadelphia, PA, 19107, United States;4. Thomas Jefferson University, Department of Surgery, 1100 Walnut Street, Philadelphia, PA, 19107, United States;1. Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy;2. Department of Surgical Oncology, Jehangir Hospital, Sassoon Road, Pune, 411001, Maharashtra, India;3. Department of Gynecologic Oncology, National Cancer Institute of Mexico, Mexico city, CP14080, Mexico;4. Department of Surgical oncology, All India Insitute of medical sciences, Ansari Nagar, New Delhi, Delhi, 110029, India;5. Department of Surgery A, Tel-Aviv Sourasky Medical Center and Sackler Fcaulty of Medicine, Tel Aviv, Israel;1. Department of surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;2. Department of pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;1. Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark;2. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark;3. Department of Pathology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen East, Denmark;1. Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hepatopancreatobiliary Surgery Department I, Beijing, PR China;2. Harbin Medical University Cancer Hospital, Department of Internal Medicine of Digestive Tumor, Harbin, Heilongjiang Province, PR China;3. Sun Yat-sen University Oncology Hospital, Department of Internal Medicine of Digestive Tumor, Guangzhou, Guangdong Province, PR China;1. Department of Surgery, Catharina Hospital Eindhoven, the Netherlands;2. GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands |
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| Abstract: | BackgroundWe sought to identify treatment disparities existing prior to publication of the 2015 American Thyroid Association Management Guidelines in order to identify patients with papillary thyroid cancer (PTC) at risk for receiving inadequate treatment.MethodsPatients diagnosed with PTC from 2011 to 2013 were identified using Surveillance, Epidemiology and End Results database. High-risk disease was defined as T4, N1, or M1. Chi-square tests compared characteristics of patients with and without high-risk disease and characteristics of high-risk patients who did and did not receive radioactive iodine ablation (RAI). Likelihoods of having high-risk disease, of receiving RAI, and of cause-specific death were calculated using regression analyses.ResultsSample included 32,229 individuals; 7894 (24.5%) had high-risk disease. Mean age was 50.0 years, 24,815 (77.0%) were female, and 21,318 (66.2%) were white. Odds of high-risk disease were greater among males (OR:2.04; 95% CI:1.92–2.16), Hispanics (OR:1.67; 95% CI:1.56–1.79) and Asians (OR:1.49; 95% CI:1.37–1.62), and uninsured (OR:1.24; 95% CI:1.07–1.43), and lower among patients ages 45–64 (OR:0.57; 95% CI:0.53–0.60), and ≥65 years (OR:0.54; 95% CI:0.50–0.59), and Blacks (OR:0.46; 95% CI:0.40–0.53). Most (69.3%) high-risk patients received RAI. Odds of receiving RAI were lower among patients age ≥65 years (OR:0.67; 95% CI:0.58–0.77), uninsured (OR:0.52; 95% CI:0.41–0.67), or with Medicaid (OR:0.58; 95% CI:0.50–0.69). RAI use reduced the risk of cause-specific mortality (HR:0.29; 95% CI:0.18–0.47).ConclusionKnowledge of these treatment disparities will allow recognition of groups at risk for high-risk disease and receiving inadequate treatment. |
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| Keywords: | Papillary thyroid carcinoma Radioactive iodine Disparity |
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