The impact of socioeconomic status on the use of adjuvant radioactive iodine for papillary thyroid cancer

Disparities in disease presentation among patients with papillary thyroid cancer: A retrospective cohort study

PURPOSE

Prior research suggests that racial and ethnic minorities present with advanced papillary thyroid cancer (PTC), traditionally defined using surgical pathology. However, marginalized populations are more likely to experience delays in surgical treatment, raising concerns that surgical staging may misrepresent the extent of disease at initial presentation. This study investigates disparities in disease presentation using cytology from Fine Needle Aspiration (FNA), which is performed at first evaluation and precedes surgery, in an institutional cohort of PTC patients.

METHODS

A single-site retrospective review of 405 patients with PTC from 2018 to 2019 evaluated the association between sociodemographic variables and the likelihood of presenting with cytologically-confirmed malignancy using FNA. Patients with malignant cytology (Bethesda VI) were compared to those with unconfirmed malignancy (Bethesda III-V). To validate the clinical significance of the Bethesda VI classification, we conducted an additional analysis examining whether these patients presented with more advanced disease.

RESULTS

Patients classified as Bethesda VI on FNA were younger and more likely to present with advanced disease features, compared to Bethesda III-V patients. On multivariable analysis, patients in the lowest income group were significantly more likely to present with Bethesda VI compared to those in the highest income group.

CONCLUSION

Differences in initial presentation were observed in our institutional cohort of PTC patients. Lower median household income was independently associated with presenting with Bethesda VI, even after adjusting for race/ethnicity. This analysis highlights the clinical relevance of considering factors beyond race and ethnicity alone to better tailor early detection efforts and strategic resource allocation, thereby addressing disparities more effectively.

Global, regional, and national burden of thyroid cancer in young people aged 10-24 years from 1990 to 2021: an analysis based on the Global Burden of Disease Study 2021

BACKGROUND

The burden of thyroid cancer (TC) among young people aged 10-24 years has not been systematically studied to date. This study aims to analyze the burden of TC among young people aged 10-24 years globally, regionally, and nationally from 1990 to 2021.

METHODS

We collected data on the incidence, mortality, and disability-adjusted life years (DALYs) rates for TC among young people aged 10-24 years from 1990 to 2021 using the Global Burden of Disease (GBD) 2021. Joinpoint regression analysis, frontier analysis, and health inequality analysis were employed to examine the variations and changes in TC burden among young people aged 10-24 years across different countries and regions.

RESULTS

From 1990 to 2021, the global burden of TC among young people has increased from 2.726 per 100,000 people [95% Uncertainty Interval (UI) 2.38-3.181] to 2.956 per 100,000 people (95% UI: 2.339-3.922), with an Average Annual Percent Change (AAPC) of 0.258 (95% Confidence Interval (CI): 0.138-0.378). The highest incidence rates were observed in Saudi Arabia, Taiwan (China), and Vietnam, while the highest mortality rates were in India, China, and Bangladesh. Frontier analysis revealed that the largest disparities in effective differences were found in the Netherlands, Germany, Canada, the United States of America, and Guinea-Bissau. The Slope Index of Inequality (SII) for DALYs increased slightly from -0.15 in 1990 to -1.3 in 2021.

CONCLUSIONS

Over the past three decades, the burden of TC has increased globally among young people, particularly in poorer countries and regions. This study highlights the importance of formulating public health policies tailored to the specific circumstances of different countries and regions aimed at reducing the TC burden among young people.

Exploring ethnic diversity and clinical outcome variabilities in well-differentiated thyroid cancer among the Asian population

BACKGROUND

Well-differentiated thyroid cancer includes papillary thyroid, follicular thyroid, and Hurthle cell cancers, comprising approximately 95% of all thyroid cancers in the United States. This study aims to understand well-differentiated thyroid cancer in the Asian population.

METHODS

We analyzed the National Cancer Database from 2004 to 2019, categorizing the Asian population based on the available ethnicities. Multivariable logistic regression assessed the associations between ethnic groups and disease stage/nodal positivity. Survival outcomes were evaluated using the Kaplan-Meier and Cox regression analyses.

RESULTS

A total of 364,604 adult patients were analyzed. The Asian ethnic groups included were Chinese (n = 3,851), Japanese (n = 740), Filipino (n = 3,466), Korean (n = 1,567), Vietnamese (n = 1,517), Laotian (n = 101), Hmong (n = 50), Kampuchean (n = 166), Thai (n = 160), Asian Indian (n = 1,526), Pakistani (n = 167), and Pacific Islander (n = 446). Japanese, Korean, and Laotian had higher percentages of stage III disease, whereas Japanese, Filipino, and Laotian had higher proportions of stage IV disease than the White population. Most Asian ethnicities had more patients with metastasis than the White population. Korean patients exhibited a 15% increased likelihood of metastasis (odds ratio: 1.15, confidence interval: 1.03-1.28, P < .05), whereas Pakistani patients were at 40% higher odds (odds ratio: 1.40, confidence interval: 1.03-1.91, P < .05), compared with White patients. Japanese, Laotian, and Kampuchean patients experienced worse 5- and 10-year overall survival than the White population.

CONCLUSION

Our study revealed substantial variation in well-differentiated thyroid cancer characteristics and outcomes among diverse Asian ethnicities. This challenges the notion of Asians as a homogeneous population, emphasizing tailored disease management for this heterogeneous group of patients.

The Role of Socioeconomic Status in Patients With Cutaneous Melanoma of the Head and Neck

OBJECTIVE

To determine the effects of socioeconomic status (SES) on cutaneous melanoma of the head and neck.

DATA SOURCE

Surveillance Epidemiology and End Results (SEER) Program.

REVIEW METHODS

We conducted a retrospective analysis of patients diagnosed with cutaneous melanoma of the head and neck from 2006 to 2018, utilizing population-based data including socioeconomic status (SES) assessed by the US-based Yost quintile index. SES quintiles ranged from Group 1 (lowest) to Group 5 (highest). We examined disease severity at diagnosis (stage, Breslow thickness, and spread) and survival outcomes (overall survival, cause-specific survival) to assess the impact of SES.

RESULTS

A total of 53,967 melanomas of the head and neck were identified (14,146 females; 39,821 males; 51,890 white; 125 black; 317 other). Group 1 patients had a significantly higher percentage of end-stage disease (stage IV) at diagnosis (n = 101; 3.2% vs. n = 280; 1.9%, respectively) (p < .001), increased Breslow thickness (.80 mm vs .60 mm, respectively) (p < .001), and higher percentage of distant disease (n = 152; 3.6% vs. n = 431; 2.1%, respectively) (p < .001). Group 1 patients experienced a higher death rate from melanoma than group 5 patients (n = 585; 14% vs n = 1,753; 8.6%). Survival increased with SES.

CONCLUSIONS

When evaluating cutaneous melanoma of the head and neck, low SES is related to more severe disease at diagnosis and worse survival outcomes. Addressing the underlying causes of this relationship could lead to more equitable management and survival outcomes.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:153-160, 2025.

Thyroid Cancer Incidence and Tumor Size in New Mexico American Indians, Hispanics, and Non-Hispanic Whites, 1992 to 2019

BACKGROUND

The incidence of thyroid cancer in the United States has risen dramatically since the 1970s, driven by an increase in the diagnosis of small tumors. There is a paucity of published New Mexico (NM) specific data regarding thyroid cancer. We hypothesized that due to New Mexico's unique geographic and cultural makeup, the incidence of thyroid cancer and tumor size at diagnosis in this state would differ from that demonstrated on a national level.

METHODS

The New Mexico Tumor Registry (NMTR) was queried to include all NM residents diagnosed with thyroid cancer between 1992 and 2019. For 2010 to 2019, age-adjusted incidence rates were calculated via direct method using the 2000 United States population as the adjustment standard. Differences in incidence rate and tumor size by race/ethnicity and residence (metropolitan vs non-metropolitan) were assessed with rate ratios between groups. For 1992 to 2019, temporal trends in age-adjusted incidence rates for major race/ethnic groups in NM [Non-Hispanic White (NHW), Hispanic, and American Indian (AI)] were assessed by joinpoint regression using National Cancer Institute software.

RESULTS

Our study included 3,161 patients for the time period 2010 to 2019, including NHW (1518), Hispanic (1425), and AI (218) cases. The overall incidence rates for NM AIs were lower than those for Hispanics and NHWs because of a decreased incidence of very small tumors (<1.1 cm). The incidence rates for large tumors (>5.1 cm) was equivalent among groups. In the early 2000s, Hispanics also had lower rates of small tumors when compared to NHWs but this trend disappeared over time.

CONCLUSION

AIs in New Mexico have been left out of the nationwide increase in incidental diagnosis of small thyroid tumors. This same pattern was noted for Hispanics in the early 2000s but changed over time to mirror incidence rates for NHWs. These data are illustrative of the health care disparities that exist among New Mexico's population and how these disparities have changed over time.

Identification and Economic Evaluation of Differentiated Thyroid Cancer Care Consumption Patterns Using Sequence Analysis

Objectives: This study aims to assess the impact of care consumption patterns and individual characteristics on the cost of treating differentiated thyroid carcinoma (DTC), in France, with a specific emphasis on socioeconomic position. Methods: The methodology involved a net cost approach utilising cases from the EVATHYR cohort and controls from the French National Health Insurance database. Care consumption patterns were created using Optimal Matching and clustering techniques. The individual characteristics influence on patterns was assessed using multinomial logistic regression. The individual characteristics and patterns influence on care costs was assessed using generalised estimating equations. Results: The findings revealed an average cost of €13,753 per patient during the initial 3 years. Regression models suggested the main predictors of high DTC specific care consumption tended to include having a high risk of cancer recurrence (OR = 4.97), being a woman (OR = 2.00), and experiencing socio-economic deprivation (OR = 1.26), though not reaching statistical significance. Finally, high DTC-specific care consumers also incurred higher general care costs (RR = 1.35). Conclusion: The study underscores the increased costs of managing DTC, shaped by consumption habits and socioeconomic position, emphasising the need for more nuanced DTC management strategies.

Correlation between socioeconomic indices and epidemiological indices of thyroid cancer from 1990 to 2019 year: a global ecologic study

BACKGROUND

The incidence of thyroid cancer as the most common type of endocrine gland malignancy has risen more significantly than any malignancies in recent years. Estimated new cases of thyroid cancer in the United States in 2024 were 12,500 and 31,520 for men and women, respectively, and estimated deaths were 1,180 for women and 990 for men. Indices of socio-economic have been commonly used to measure the development of countries. Therefore, this study aimed to examine the correlation between indices of socioeconomic status and epidemiological indices of thyroid cancer throughout the world. In addition, this study has compared two indices of human development and a socio-demographic index.

METHOD

This worldwide ecological study used data on thyroid cancer incidence, mortality, human development index (HDI), and sociodemographic index (SDI) between 1990 and 2019 from the Global Burden of Disease (GBD). We evaluated the correlation between incidence and mortality rates with socioeconomic indices by using Pearson's correlation coefficient. Furthermore, for the first time, the generalized additive model (GAM) was employed for modeling. The statistical software R, version 4.2.2, was used to conduct all statistical analyses.

RESULTS

The correlation between the incidence of thyroid cancer and the HDI was significant and positive (r = 0.47, p-value < 0.001). While the correlation between thyroid cancer mortality and HDI was not statistically significant (r = 0.01, p-value = 0.076). Besides, the incidence of thyroid cancer was significantly positively correlated with SDI (r = 0.48, p-value < 0.001). The multiple GAM showed that for one unit increase in HDI, the risk of thyroid cancer was increased by 2.1 times (RR = 2.1, 95%CI = 2.04 to 2.19), and for one unit increase in SDI, the risk of thyroid cancer was shown to increase by 2.2 times. (RR = 2.2, 95%CI = 2.19 to 2.35).

CONCLUSION

It has been evident that countries with higher incidence of thyroid cancer display higher socioeconomic indices. While, countries with higher socioeconomic indices, report lower mortality rates. However, based on the modeling results, it can be concluded that the SDI is slightly more useful in this regard. Therefore, examining the epidemiological indices of thyroid cancer by socio-economic indices can be useful to reflect a clear image of the distribution of this cancer in each country, and can be used for planning cancer prevention strategies.

The impact of social determinants of health on thyroid cancer mortality and time to treatment

BACKGROUND

Whereas racial disparities in thyroid cancer care are well established, the role of social determinants of health is less clear. We aimed to assess the individual and cumulative impact of social determinants of health on mortality and time to treatment among patients with thyroid cancer.

METHODS

We collected social determinants of health data from thyroid cancer patients registered in the National Cancer Database from 2004 to 2017. We created a count variable for patients in the lowest quartile of each social determinant of health (ie, low income, low education, and no insurance). We assessed the association of social determinants of health with mortality and time to treatment and the association between cumulative social determinants of health count and time to treatment using Cox regression.

RESULTS

Of the 142,024 patients we identified, patients with longer time to treatment had greater mortality compared to patients treated within 90 days (90-180 days, adjusted hazard ratio 1.21 (95% confidence interval 1.13-1.29, P < .001); >180 days, adjusted hazard ratio 1.57 (95% confidence interval 1.41-1.76, (P < .001). Compared to patients with no adverse social determinants of health, patients with 1, 2, or 3 adverse social determinants of health had a 10%, 12%, and 34%, respectively, higher likelihood of longer time to treatment (1 social determinant of health, hazard ratio 0.90, 95% confidence interval 0.89-0.92, P < .001; 2 social determinants of health, hazard ratio 0.88, 95% confidence interval 0.87-0.90, P < .001; 3 social determinants of health, hazard ratio 0.66, 95% confidence interval 0.62-0.71, P < .001 for all). On subgroup analysis by race, each adverse social determinant of health was associated with an increased likelihood of a longer time to treatment for Black and Hispanic patients (P < .05).

CONCLUSION

A greater number of adverse social determinants of health leads to a higher likelihood of a longer time to treatment for patients with thyroid cancer, which, in turn, is associated with an increased risk for mortality.

Insurance-Based Disparities in Guideline-Concordant Thyroid Cancer Care in the Era of De-escalation

INTRODUCTION

Prior studies have demonstrated insurance-based disparities in the treatment of well-differentiated thyroid cancer. However, it remains unclear whether these disparities have persisted in the era of the 2015 American Thyroid Association (ATA) management guidelines. The goal of this study was to assess whether insurance type is associated with the receipt of guideline-concordant and timely thyroid cancer treatment in a modern cohort.

METHODS

Patients diagnosed with well-differentiated thyroid cancer between 2016 and 2019 were identified from the National Cancer Database. Appropriateness of surgical and radioactive iodine treatment (RAI) was determined based on the 2015 ATA guidelines. Multivariable logistic regression and Cox proportional hazard regression analyses, stratified at age 65, were used to evaluate the associations between insurance type and appropriateness and timeliness of the treatment.

RESULTS

125,827 patients were included (private = 71%, Medicare = 19%, Medicaid = 10%). Compared to privately insured patients, patients with Medicaid more frequently presented with tumors >4 cm in size (11% versus 8%, P < 0.001) and regional metastases (29% versus 27%, P < 0.001). However, patients with Medicaid were also less likely to undergo appropriate surgical treatment (odds ratio 0.69, P < 0.001), less likely to undergo surgery within 90 d of diagnosis (hazard ratio 0.80, P < 0.001), and more likely to be undertreated with RAI (odds ratio 1.29, P < 0.001). There were no differences in the likelihood of guideline-concordant surgical or medical treatment by insurance type in patients ≥65 y old.

CONCLUSIONS

In the era of the 2015 ATA guidelines, patients with Medicaid remain less likely to receive guideline-concordant, timely surgery and more likely to be undertreated with RAI compared to privately insured patients.

Thyroid cancer

The past 5-10 years have brought in a new era in the care of patients with thyroid cancer, with the introduction of transformative diagnostic and management options. Several international ultrasound-based thyroid nodule risk stratification systems have been developed with the goal of reducing unnecessary biopsies. Less invasive alternatives to surgery for low-risk thyroid cancer, such as active surveillance and minimally invasive interventions, are being explored. New systemic therapies are now available for patients with advanced thyroid cancer. However, in the setting of these advances, disparities exist in the diagnosis and management of thyroid cancer. As new management options are becoming available for thyroid cancer, it is essential to support population-based studies and randomised clinical trials that will inform evidence-based clinical practice guidelines on the management of thyroid cancer, and to include diverse patient populations in research to better understand and subsequently address existing barriers to equitable thyroid cancer care.

Current Controversies in Low-Risk Differentiated Thyroid Cancer: Reducing Overtreatment in an Era of Overdiagnosis

CONTEXT

Low-risk differentiated thyroid cancer (DTC) is overdiagnosed, but true incidence has increased as well. Owing to its excellent prognosis with low morbidity and mortality, balancing treatment risks with risks of disease progression can be challenging, leading to several areas of controversy.

EVIDENCE ACQUISITION

This mini-review is an overview of controversies and difficult decisions around the management of all stages of low-risk DTC, from diagnosis through treatment and follow-up. In particular, overdiagnosis, active surveillance vs surgery, extent of surgery, radioactive iodine (RAI) treatment, thyrotropin suppression, and postoperative surveillance are discussed.

EVIDENCE SYNTHESIS

Recommendations regarding the diagnosis of DTC, the extent of treatment for low-risk DTC patients, and the intensity of posttreatment follow-up have all changed substantially in the past decade. While overdiagnosis remains a problem, there has been a true increase in incidence as well. Treatment options range from active surveillance of small tumors to total thyroidectomy followed by RAI in select cases. Recommendations for long-term surveillance frequency and duration are similarly broad.

CONCLUSION

Clinicians and patients must approach each case in a personalized and nuanced fashion to select the appropriate extent of treatment on an individual basis. In areas of evidential equipoise, data regarding patient-centered outcomes may help guide decision-making.

Disparities in Thyroid Care

Thyroid disease affects an estimated 20 million Americans, with 1 in 8 women developing a thyroid disorder during her lifetime. Although most patients with thyroid cancer have a good prognosis and effective treatments for benign thyroid disease are available, disparities exist in thyroid care and result in worse outcomes for racial and ethnic minorities. Inequities in the diagnosis and treatment of thyroid disease are due to the complex interplay of systems-, physician-, and patient-level factors. Thus, innovative strategies that take an ecological approach to addressing racial disparities are needed to achieve equitable care for all patients with thyroid disease.

The association of low socioeconomic status with advanced stage thyroid cancer

Objectives

This study investigates the link between low socioeconomic status (SES) and advanced thyroid cancer at the time of detection. It also assesses the socioeconomic variables that may potentially affect the stage of thyroid cancer at presentation.

Methods

This retrospective cohort study was conducted on patients with thyroid cancer between January 2016 and April 2020. The data were collected using the patients' medical records from the hospital information system (BESTcare) and through interview-based surveys. To assess the factors predicting the stage of advanced thyroid cancer, socioeconomic status (SES) predictors like area of residency, educational level, income, and marital status were collected.

Results

A total of 220 patients with thyroid cancer were included in this study. Male patients (p = 0.025), older than 55 years (p < 0.001), living in rural areas (p = 0.002), with low educational level (p = 0.021) were found to be significantly associated with advanced-stage thyroid cancer at presentation. Multivariate analysis showed that gender (men) and age (above 55 years) were significant predictors of advanced stage thyroid cancer. However, no association between income and the stage of thyroid cancer has been found in this study.

Conclusion

This study has shown that even in a country like KSA with a strong government-funded healthcare system, health disparity among people battling thyroid cancer exists. Our study has found that SES factors have a significant impact on the stage of thyroid cancer at the time of presentation, whereas the economic status of the patients had no impact on the stage of thyroid cancer. Furthermore, patients in lower SES groups were diagnosed with more advanced stages at presentation.

Comparing surgical thoroughness and recurrence in thyroid cancer patients across race/ethnicity

BACKGROUND

For patients with differentiated thyroid cancer who will receive postoperative radioactive iodine, thyroid remnant uptake can be calculated and may point to the thoroughness of the surgical resection. In the United States, outcome disparities exist among ethnic/racial minorities with differentiated thyroid cancer. Data about surgical thoroughness and recurrence rates across races/ethnicities do not exist. This study compared the amount of thyroid remnant uptake and cancer recurrence rates across race/ethnicity.

METHODS

This was a retrospective analysis of adult patients with differentiated thyroid cancer who had postoperative radioactive iodine in 2017 and 2018 and were followed to 2020. We collected thyroid bed remnant uptake from postoperative radioactive iodine scans and analyzed it as a ratio of percent of uptake to dose of radioactive iodine received to control for varying radioactive iodine doses. Thyroid remnant, uptake to dose of radioactive iodine received, and recurrence were evaluated across race/ethnicity.

RESULTS

Of 218 patients: 61% were White, 21% Black, 11% Asian, and 7% Hispanic; 72% were female. Seventy-one percent of patients had their surgery done by a high-volume surgeon, although volume data were not available for all. In White, Black, Asian, and Hispanic patients, median uptake was 0.68%, 0.44%, 1.5%, and 0.8%, respectively (P = .13). We did not observe differences in median uptake to dose of radioactive iodine received across groups (P = .41). Recurrence rate was 17.0% among White patients, 16.7% among Black patients, 17.6% among Asian patients, and 16.7% among Hispanic patients (P = 1.00).

CONCLUSION

We did not observe differences across race/ethnicity in surgical thoroughness or rate of recurrence. These findings suggest that disparities may be mitigated when ethnic/racial minorities have similar access to quality surgical care.

Socioeconomic factors are associated with the prognosis of Thyroid Cancer

Background: Thyroid adenomas/adenocarcinomas are the most common type of thyroid cancer. The impact of socioeconomic factors on the prognosis of thyroid cancer is unclear.

Methods: Clinical information and socioeconomic factors were obtained from the Surveillance, Epidemiology, and End Results Database (SEER) 18 Registries Custom Database. The association between thyroid adenomas/adenocarcinomas and socioeconomic factors including gender, race/ethnicity, insurance status, marital status, living area, and Yost index (including education, income, working, etc.) were fully evaluated.

Results: A total of 136,313 patients between 2010 and 2016 were finally included in the present study. Among them, 126,160 patients were diagnosed with the single malignancy. Median follow-up time was 64 months. In general, non-Hispanic Asian or Pacific Islander and Hispanic patients had significantly better survival than non-Hispanic White patients (All P <0.05). Patients insured by Medicaid had significantly poorer cancer-specific survival (CSS, hazard ratio, HR=2.15, P <0.001) and overall survival (OS, HR=2.42, P <0.001) than those insured by commercial insurance or Medicare. In addition, divorced or widowed status, rural living location and low Yost index were significantly associated with poor CSS and OS of thyroid adenomas/adenocarcinomas (All P <0.05). Subgroup analyses showed similar results in patients who received surgical procedure, as well as in patients who received both surgical and radiation therapy. Multivariate analyses suggested that insurance status, marital status and Yost index remained significantly associated with CSS and OS (all P <0.05).

Conclusions: Socioeconomic factors, including insurance status, marital status, living area, and Yost index, were significant predictors for the survival of thyroid adenomas/adenocarcinomas.

Disparities Research in Thyroid Cancer: Challenges and Strategies for Improvement

Until recently, thyroid cancer was one of the most rapidly increasing cancers in the United States. Disparities exist in many aspects of thyroid cancer care as a result of the multifactorial interplay of systemic, patient, and physician factors. To better understand the management of thyroid cancer in populations at risk for health disparities and subsequently implement changes that will lead to health equity for all patients with thyroid cancer, health services research with innovative approaches is necessary.

Socioeconomic disparities in a population of patients undergoing total thyroidectomy for benign disease

BACKGROUND

This study examines the effect of insurance status (as a measure of socioeconomic status) on patient with benign thyroid disease.

METHODS

A retrospective review was performed among 60 patients undergoing total thyroidectomy for benign thyroid disease. Univariate and multivariable analyses examined the relationship between insurance status and thyroid volume (sum of the left and right lobe volumes).

RESULTS

Twenty-eight (47%) patients were considered of underinsured/uninsured status, and 32 (53%) patients were considered of private/government/military insurance status. Median pathologic whole thyroid volume was 66 mL (range, 2-855). After multivariable linear regression, underinsured/uninsured status was the only significant predictor of larger volume (correlation coefficient [r] = 118; 95% CI, 42 to 194; P = .003), after adjusting for age, sex, body mass index, and presence of concomitant thyroid disease and compressive symptoms.

CONCLUSION

Patients of underinsured/uninsured status suffered more severe disease presentations at time of thyroidectomy, as measured by larger thyroid volumes.

Decreasing Use of Radioactive Iodine for Low-Risk Thyroid Cancer in California, 1999 to 2015

CONTEXT

Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines.

OBJECTIVE

To assess recent stage-specific trends in use of RAI ablation.

DESIGN, SETTING, AND PATIENTS

Retrospective study of patients with DTC (1999 to 2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, P values, and multivariable analyses using RAI as the predictor variable.

MAIN OUTCOME MEASURES

Trends and drivers of RAI ablation for low-risk DTC.

RESULTS

Of 46,906 patients with DTC who underwent near-total or total thyroidectomy [mean age 48.2 ± 15.5 (standard deviation) years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Use of RAI for patients with localized disease (no extrathyroidal extension, lymph node, or distant metastases) decreased from 55% (1999) to 30% (2015), with the most substantial change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1 and 2 cm (62% to 34%) and 2 and 4 cm (67% to 49%) and remained stable at 59% for tumors >4 cm. In multivariable analyses, patients with localized disease were less likely to receive RAI if they were >65 years old [odds ratio (OR) 0.77, 95% confidence interval (CI): 0.71 to 0.83], had tumors <1 cm (OR 0.33, 95% CI: 0.31 to 0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67 to 0.75).

CONCLUSIONS

The rate of RAI ablation decreased over time, mainly attributable to decreased use for localized DTCs <2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.

National Trends in the Surgical Treatment of Non-advanced Medullary Thyroid Cancer (MTC): An Evaluation of Adherence with the 2009 American Thyroid Association Guidelines

BACKGROUND

Medullary thyroid cancer (MTC) represents the third most common type of thyroid cancer, and the prognosis depends on the stage of the disease at diagnosis and completeness of tumor resection. In 2009, the American Thyroid Association (ATA) published guidelines with evidence-based recommendations for the treatment of MTC. This study aimed to determine national adherence rates of the treatment according to the ATA guidelines specific for MTC.

METHODS

Patients diagnosed with MTC from 2004 to 2013 were identified from the National Cancer Database. Guideline adherence rates for the treatment of MTC before and after the publication of ATA guidelines were analyzed and compared to determine patient and clinical variables that affected treatment.

RESULTS

A total of 3693 patients diagnosed with MTC were identified. We found 60.3 % of the patients had localized MTC and 39.7 % had regional metastases. Older age, female sex and having Medicaid or being uninsured were directly correlated with more advanced disease upon diagnosis (p < 0.001). Overall, a greater proportion of patients received care in accordance with the recommendations following the ATA guidelines' publication in 2009: 61.4 % of patients treated between 2004 and 2008 versus 66.8 % of patients treated between 2009 and 2013 received care in accordance with the recommendations (p < 0.01). Factors such as older age, African American race, localized disease at diagnosis, lower estimated median zip code household income and being treated in a community versus an academic hospital were associated with a lower likelihood of receiving care in accordance with the guidelines.

CONCLUSION

Adherence rates to the ATA recommendations for the treatment of MTC increased modestly following the publication of guidelines in 2009 with the largest increase seen in community hospitals. Being older, African American, diagnosed with localized disease and treated in a community hospital rather than in an academic institution was correlated with a lower likelihood of receiving treatment in accordance with the guidelines. Efforts should be made to continuously increase the adherence rates to the MTC ATA guidelines and to decrease socioeconomic disparities that continue to exist in the treatment of MTC.

Effects of socioeconomic status on children with well-differentiated thyroid cancer

BACKGROUND

Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood.

METHODS

Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable.

RESULTS

A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment (P < .002). Similarly, uninsured children had a longer time from diagnosis to treatment (28 days) compared with those with government (19 days) or private (18 days) insurance (P < .001). Despite being diagnosed at a higher stage and having a longer time interval between diagnosis and treatment, there was no significant difference in either overall survival or rates of unplanned readmissions based on any of the socioeconomic surrogate variables.

CONCLUSION

Children from lower income families and those lacking insurance experienced a longer period from diagnosis to treatment of their well-differentiated thyroid cancer remains. These patients also presented with higher stage disease. These data suggest a delay in care for children from low-income families. Although these findings did not translate into worse outcomes for well-differentiated thyroid cancer remains, future efforts should focus on reducing these differences.

The role of race in thyroid cancer: systematic review

BACKGROUND

The incidence of thyroid cancer is increasing. There is conflicting evidence as to why. However, studies suggest that it is not an apparent increase resulting from enhanced diagnostic practices, but a true increase with more affected patients. This study aimed to assess racial variation in thyroid cancer.

METHOD

A narrative systematic review of the literature was conducted.

RESULTS

Eight retrospective cohort studies were identified, comprising 611 777 adult patients. Variations exist between racial groups, which are also dependent on gender; white patients have a slightly higher male population when compared to their counterparts. Black and white patients have a higher proportion of follicular cancer. Hispanics were younger at the age of diagnosis. Outcomes are greatly affected by socioeconomic status.

CONCLUSION

This study identified many gaps in the way that these types of data are presented. A more concise manner of reporting, with individual-level risk factors, is recommended.

Demographic and socioeconomic factors predictive of compliance with American Thyroid Association guidelines for the treatment for advanced papillary thyroid carcinoma

BACKGROUND

The American Thyroid Association (ATA) publishes evidence-based guidelines for the treatment of papillary thyroid carcinoma (PTC). We sought to identify factors associated with receiving treatment compliant with the 2006 ATA guidelines for advanced-stage PTC.

METHODS

The 2006 ATA guideline compliance was examined in patients with stage III and IV PTC extrapolated from Surveillance, Epidemiology, and End Results (SEER).

RESULTS

Sixty percent of patients received ATA-compliant treatment. A stepwise increase in compliance occurred between 2006 and 2009 (p-value trend = .0003). Age 45 to 64 years versus ≥65 (odds ratio [OR] = 0.682; 95% confidence interval [CI] = 0.57-0.81; p < .0001) and higher income (p trend = .012) were associated with an increased likelihood of receiving ATA-compliant care. African Americans (OR = 0.56; 95% CI = 0.42-0.76; p = .0001) and single patients (OR = 0.81; 95% CI = 0.67-0.97; p = .02) were less likely to receive ATA-compliant care.

CONCLUSION

This study highlights specific populations at risk for receiving non-ATA-compliant care for PTC and underscores the need to further implement guideline-based practice.