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Saïe C, Marchand V, Zhang-Yin J, Ers V, Mauel E. Evolution in the management of thyroid surgery over a period of 15 years in a Belgian center. BMC Surg 2024; 24:188. [PMID: 38877435 PMCID: PMC11179191 DOI: 10.1186/s12893-024-02471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze the change made in operative thyroid management and the impact on thyroid cancer diagnosis. BACKGROUND Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease overdiagnosis of low risk thyroid cancer. Our goal was to study the evolution, over a long period, of pre- and postoperative management and the influence on histological cancer diagnosis and, more particularly, microcancer. METHODS In this retrospective cohort study, we included 891 consecutive patients who underwent thyroid surgery between 2007 and 2020. RESULTS Respectively 305, 290 and 266 patients underwent surgery over the 3 periods of 2007-2010, 2011-2015 and 2016-2020. In all three periods, women represented approximately 70% of the population, and the mean age was 54 years old (range: 67). Most surgeries (90%) involved total thyroidectomies. Over the study period, the proportion of preoperative fine needle aspiration (FNA) increased from 13 to 55%, p < 0,01. Cancer was found in a total of 116 patients: 35 (11%) patients between 2007 and 2010, 50 (17%) between 2011 and 2015 and 32 (12%) between 2016 and 2020 (p = 0.08). For all 3 periods, papillary thyroid cancer (PTC) was the most prevalent, at approximately 80%. The proportion of thyroid cancer > T1a increased significantly from 37% (2011-2015 period) to 81% (2016-2020 period), p = 0.001. Patients treated with radioiodine remained relatively stable (approximately 60%) but were more frequently treated with a low dose of radioiodine (p < 0.01) and recombinant human TSH (p < 0.01). Operative thyroid weight decreased over time in all but the low-risk T1a PTC cases. CONCLUSIONS Over a period of 15 years and according to the evolution of recommendations, the care of patients who underwent thyroid surgery changed with the increased use of preoperative FNA. This change came with a decrease in low-risk T1a PTC.
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Affiliation(s)
- Clotilde Saïe
- Department of Endocrinology, Clinique du Sud Luxembourg, Arlon, Belgium.
- , Vivalia Arlon, avenue des déportés 137, Arlon, 6700, Belgium.
| | - Victor Marchand
- Department of Surgery, Clinique du Sud Luxembourg, Arlon, Belgium
| | - Jules Zhang-Yin
- Department of Nuclear Medicine, Clinique du Sud Luxembourg, Arlon, Belgium
| | - Vincent Ers
- Department of Endocrinology, Clinique du Sud Luxembourg, Arlon, Belgium
| | - Etienne Mauel
- Department of Surgery, Clinique du Sud Luxembourg, Arlon, Belgium
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2
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Huang J, Jones DR. Completion of accrual for Thoracic Surgical Oncology Group 102: One small step forward for thoracic clinical trials. J Thorac Cardiovasc Surg 2024; 167:1589-1590. [PMID: 38295952 DOI: 10.1016/j.jtcvs.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Affiliation(s)
- James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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3
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Collins KK, Smith CF, Ford T, Roberts N, Nicholson BD, Oke JL. Adequacy of clinical guideline recommendations for patients with low-risk cancer managed with monitoring: systematic review. J Clin Epidemiol 2024; 169:111280. [PMID: 38360377 DOI: 10.1016/j.jclinepi.2024.111280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES The aim of this systematic review was to summarize national and international guidelines that made recommendations for monitoring patients diagnosed with low-risk cancer. It appraised the quality of guidelines and determined whether the guidelines adequately identified patients for monitoring, specified which tests to use, defined monitoring intervals, and stated triggers for further intervention. It then assessed the evidence to support each recommendation. STUDY DESIGN AND SETTING Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched PubMed and Turning Research into Practice databases for national and international guidelines' that were written in English and developed or updated between 2012 and 2023. Quality of individual guidelines was assessed using the AGREE II tool. RESULTS Across the 41 published guidelines, 48 different recommendations were identified: 15 (31%) for prostate cancer, 11 (23%) for renal cancer, 6 (12.5%) for thyroid cancer, and 10 (21%) for blood cancer. The remaining 6 (12.5%) were for brain, gastrointestinal, oral cavity, bone and pheochromocytoma and paraganglioma cancer. When combining all guidelines, 48 (100%) stated which patients qualify for monitoring, 31 (65%) specified which tests to use, 25 (52%) provided recommendations for surveillance intervals, and 23 (48%) outlined triggers to initiate intervention. Across all cancer sites, there was a strong positive trend with higher levels of evidence being associated with an increased likelihood of a recommendation being specific (P = 0.001) and the evidence for intervals was based on expert opinion or other guidance. CONCLUSION With the exception of prostate cancer, the evidence base for monitoring low-risk cancer is weak and consequently recommendations in clinical guidelines are inconsistent. There is a lack of direct evidence to support monitoring recommendations in the literature making guideline developers reliant on expert opinion, alternative guidelines, or indirect or nonspecific evidence.
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Affiliation(s)
- Kiana K Collins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
| | - Claire Friedemann Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Tori Ford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, OX1 3BG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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4
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Awny S, Abdallah A, Metwally IH, Abdelwahab K, Zuhdy M, Hamdy O, Fareed AM, Atallah K. Impact of age on central lymph nodes involvement in papillary thyroid cancer. BMC Cancer 2024; 24:423. [PMID: 38580902 PMCID: PMC10998331 DOI: 10.1186/s12885-024-12198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Total thyroidectomy is the main line of treatment for papillary thyroid cancer. Central lymph node dissection (CLND) is still debatable. In this study, we aimed to correlate the central lymph node status with the age of patients. METHODS This is a retrospective study including patients with papillary thyroid cancer (PTC) who underwent total thyroidectomy and CLND at a tertiary cancer center during the period from January 2012 to September 2022. Patients were subdivided into 3groups: patients younger than 20 years old, patients between 20 and 40 years old, and patients older than 40 years old. Correlation between central lymph node status, lateral lymph node status, and harvest count with each other and between age groups was done. RESULTS 315 patients were included. The younger the age group the higher the possibility of harboring positive central nodes, however, the positivity of lateral nodes was similar. Neither central nodal harvest nor positive central node count significantly differed between groups. The lateral nodal harvest was significantly higher in the < 20 years group with no affection to the number of positive nodes retrieved. The younger the age group the longer the disease-free survival (DFS). CONCLUSION We can conclude that patients younger than twenty years had a higher probability of harboring malignancy in central nodes and higher lateral node harvest on dissection. In contrast, they do have a lower incidence of recurrence.
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Affiliation(s)
- Shadi Awny
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Ahmed Abdallah
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Khaled Abdelwahab
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Mohammad Zuhdy
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt.
| | - Ahmed M Fareed
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Khalid Atallah
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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Sahoo TP, Desai C, Agarwal S, Rauthan A, Dhabhar B, Biswas G, Batra S, Saha R, Philip A, Agarwal V, Dattatreya PS, Mohapatra PN, Deshmukh C, Bhagat S, Patil S, Barkate H. ExPert ConsEnsus on the management of Advanced clear-cell RenaL celL carcinoma: INDIAn Perspective (PEARL-INDIA). BMC Cancer 2023; 23:737. [PMID: 37558975 PMCID: PMC10413514 DOI: 10.1186/s12885-023-11237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023] Open
Abstract
In advanced Renal Cell Carcinoma (aRCC), systemic therapy is the mainstay of treatment, with no or little role for surgery in these patients. Tyrosine kinase inhibitors (TKIs) and immune-oncological (IOs) therapies, either alone or in combination, are recommended in these patients depending on patient and tumour factors. The sequencing of therapies is critical in RCC because the choice of subsequent line therapy is heavily dependent on the response and duration of the previous treatment. There are additional barriers to RCC treatment in India. Immunotherapy is the cornerstone of treatment in ccRCC, but it is prohibitively expensive and not always reimbursed, effectively putting it out of reach for the vast majority of eligible patients in India. Furthermore, in advanced RCC (particularly the clear cell variety), Indian oncologists consider the disease burden of the patients, which is particularly dependent on the quantum of the disease load, clinical symptoms, and performance status of the patient, before deciding on treatment. There are no India-specific guidelines for clear cell RCC (ccRCC) treatment or the positioning and sequencing of molecules in the management of advanced ccRCC that take these country-specific issues into account. The current consensus article provides expert recommendations and treatment algorithms based on existing clinical evidence, which will be useful to specialists managing advanced ccRCC.
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Affiliation(s)
| | - Chirag Desai
- Medical Oncology & Director Hemato-Oncology Clinic Vedanta, Ahmedabad, Ahmedabad, India
| | - Shyam Agarwal
- Medical Oncology, Sir Gangaram Hospital, Delhi, India
| | - Amit Rauthan
- Medical Oncology, Manipal Hospital, Bangalore, India
| | - Boman Dhabhar
- Medical & Hemat-Oncology, BND Onco Center, Mumbai, India
| | | | - Sandeep Batra
- Medical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajat Saha
- Medical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Arun Philip
- Medical Oncology Amrita Institute of Medical Sciences, Cochin, India
| | - Vijay Agarwal
- Medical Oncology Aster, CMI Hospital, Bangalore, India
| | | | | | - Chetan Deshmukh
- Medical Oncology, Deenanath Mangeshkar Hospital, Pune, India
| | - Sagar Bhagat
- DGM, Global Medical Affairs, Glenmark Pharmaceutical Limited, B D Sawant Marg, Chakala, Andheri East, Maharashtra, 400099, Mumbai, India.
| | - Saiprasad Patil
- GM, Global Medical Affairs, Glenmark Pharmaceutical Limited, Mumbai, India
| | - Hanmant Barkate
- Medical Affairs, Glenmark Pharmaceutical Limited, Mumbai, India
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Toraih EA, Ruiz E, Ning B, Tortelote GG, Hilliard S, Moroz K, Hu T, Fawzy MS, Kandil E. Chromatin-Accessible miRNA Regulons Driving Thyroid Tumorigenesis and Progression. J Am Coll Surg 2023; 236:732-750. [PMID: 36728308 DOI: 10.1097/xcs.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although papillary thyroid cancer can remain indolent, associated lymph node metastases and recurrence rates are approximately 50% and 20%, respectively. Omics-based medicine has led to the discovery of predictive biomarkers that can be used to predict tumor progression and clinical outcomes. We aimed to develop a noninvasive omics-driven blood test to allow accurate risk stratification and help tailor individual patient treatment plans. STUDY DESIGN RNA sequencing (seq) and microRNA analysis of The Cancer Genome Atlas and Gene Expression Omnibus datasets were employed to identify an epigenetic prognostic panel. Integrated bulk assay for transposase-accessible chromatin-seq and RNA-seq experiments confirmed the results. Sixty-two paired tumor and adjacent control thyroid tissues and 67 blood samples (62 papillary thyroid cancer and 5 controls) were analyzed for validation using sequencing and real-time polymerase chain reaction and correlated to clinical outcomes. A liposome-exosome fusion clustered regularly interspaced short palindromic repeats (CRISPR)-fluorescent detection system miRNA assay was developed. A predictive risk nomogram was generated and tested for performance. RESULTS Our miRNA panel (miR-146b-5p and miR-221-3p) from tissue and blood was associated with aggressive features and was located within accessible chromatin regions. The miRNA risk score and prognostic nomogram showed higher accuracy in predicting lymph node metastases (miR-146b: area under the curve [AUC] 0.816, sensitivity 76.9%; miR-221: AUC 0.740, sensitivity 79.5%) and recurrence (miR-146b: AUC 0.921, sensitivity 75.0%; miR-221: AUC 0.756, sensitivity 70.0%; p < 0.001) than staging and American Thyroid Association risk stratification. CRISPR-based miRNA assays showed upregulation in the blood of cancer cohorts. CONCLUSIONS CRISPR-based detection of miR-146b and miR-221 in the blood of thyroid cancer patients is a reliable and noninvasive tool for real-time assessment and prognostication that has great potential to provide a direct impact on the care of these patients.
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Affiliation(s)
- Eman A Toraih
- From the Division of General Endocrine and Oncologic Surgery, Department of Surgery (Toraih, Kandil), Tulane University School of Medicine, New Orleans, LA
- the Medical Genetics Unit, Department of Histology and Cell Biology (Toraih); Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, and Suez Canal University, Ismailia, Egypt
| | - Emmanuelle Ruiz
- the Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA (Ruiz)
| | - Bo Ning
- Department of Biochemistry and Molecular Biology (Ning, Hu), Tulane University School of Medicine, New Orleans, LA
| | - Giovane G Tortelote
- Section of Pediatric Nephrology, Department of Pediatrics (Tortelote, Hilliard), Tulane University School of Medicine, New Orleans, LA
| | - Sylvia Hilliard
- Section of Pediatric Nephrology, Department of Pediatrics (Tortelote, Hilliard), Tulane University School of Medicine, New Orleans, LA
| | - Krzysztof Moroz
- Department of Pathology and Laboratory Medicine (Moroz), Tulane University School of Medicine, New Orleans, LA
| | - Tony Hu
- Department of Biochemistry and Molecular Biology (Ning, Hu), Tulane University School of Medicine, New Orleans, LA
| | - Manal S Fawzy
- the Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia (Fawzy)
| | - Emad Kandil
- From the Division of General Endocrine and Oncologic Surgery, Department of Surgery (Toraih, Kandil), Tulane University School of Medicine, New Orleans, LA
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Phelps TE, Yilmaz EC, Harmon SA, Belue MJ, Shih JH, Garcia C, Hazen LA, Toubaji A, Merino MJ, Gurram S, Choyke PL, Wood BJ, Pinto PA, Turkbey B. Ipsilateral hemigland prostate biopsy may underestimate cancer burden in patients with unilateral mpMRI-visible lesions. Abdom Radiol (NY) 2023; 48:1079-1089. [PMID: 36526922 PMCID: PMC10765956 DOI: 10.1007/s00261-022-03775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the cancer detection rates of reduced-core biopsy schemes in patients with unilateral mpMRI-visible intraprostatic lesions and to analyze the contribution of systematic biopsy cores in clinically significant prostate cancer (csPCa) detection. METHODS 212 patients with mpMRI-visible unilateral intraprostatic lesions undergoing MRI/TRUS fusion-guided targeted biopsy (TBx) and systematic biopsy (SBx) were included. Cancer detection rates of TBx + SBx, as determined by highest Gleason Grade Group (GG), were compared to 3 reduced-core biopsy schemes: TBx alone, TBx + ipsilateral systematic biopsy (IBx; MRI-positive hemigland), and TBx + contralateral systematic biopsy (CBx; MRI-negative hemigland). Patient-level and biopsy core-level data were analyzed using descriptive statistics with confidence intervals. Univariable and multivariable logistic regression analysis was conducted to identify predictors of csPCa (≥ GG2) detected in MRI-negative hemiglands at p < 0.05. RESULTS Overall, 43.4% (92/212) of patients had csPCa and 66.0% (140/212) of patients had any PCa detected by TBx + SBx. Of patients with csPCa, 81.5% had exclusively ipsilateral involvement (MRI-positive), 7.6% had only contralateral involvement (MRI-negative), and 10.9% had bilateral involvement. The csPCa detection rates of reduced-core biopsy schemes were 35.4% (75/212), 40.1% (85/212), and 39.6% (84/212) for TBx alone, TBx + IBx, and TBx + CBx, respectively, with detection sensitivities of 81.5%, 92.4%, and 91.3% compared to TBx + SBx. CONCLUSION Reduced-core prostate biopsy strategies confined to the ipsilateral hemigland underestimate csPCa burden by at least 8% in patients with unilateral mpMRI-visible intraprostatic lesions. The combined TBx + SBx strategy maximizes csPCa detection.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stephanie A Harmon
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Joanna H Shih
- Biometric Research Program, National Cancer Institute, NIH, Rockville, MD, USA
| | - Charisse Garcia
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Lindsey A Hazen
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Antoun Toubaji
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
- Department of Radiology, Clinical Center, NIH, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA.
- Molecular Imaging Branch, National Cancer Institute, 10 Center Dr., MSC 1182, Building 10, Room B3B85, Bethesda, MD, 20892-1088, USA.
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8
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Seo GT, Urken ML, Wein LE, Saturno MP, Kapustin D, Xing MH, Yue LE, Dowling EM, Revenson TA, Roberts KJ, Tuttle RM. Psychological adjustment to initial treatment for low-risk thyroid cancer: Preliminary study. Head Neck 2023; 45:439-448. [PMID: 36495223 DOI: 10.1002/hed.27265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low-risk papillary thyroid carcinoma (LR-PTC) can be managed by immediate surgery (IS) or active surveillance (AS). We compare the psychological impact of these treatments on patients with LR-PTC. METHODS Psychological data were collected over 1 year, with assessments at the time of treatment decision (T1), at 6 months (T2) and 12 months (T3) follow-up. Assessments included 13 validated psychological tools. RESULTS Of 27 enrolled patients, 20 chose AS and 7 chose IS. The average times to T2 and T3 were 5.7 and 11.3 months, respectively. For both groups, Impact of Events Scale scores significantly decreased (p = 0.001) at T2, and depressive/anxiety symptoms remained low. CONCLUSIONS This study demonstrates the feasibility of assessing psychological outcomes among patients treated for LR-PTC. Further studies are needed to evaluate the impact of AS versus IS on quality of life and changes that patients experience over longer time periods following their treatment decision.
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Affiliation(s)
- Gabriella T Seo
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren E Wein
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Michael P Saturno
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Danielle Kapustin
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey A Revenson
- Department of Psychology, Hunter College, City University of New York, New York, New York, USA
| | - Katherine J Roberts
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York, USA
| | - Robert Michael Tuttle
- Endocrinology Service-Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Wang X, Chan YS, Wong K, Yoshitake R, Sadava D, Synold TW, Frankel P, Twardowski PW, Lau C, Chen S. Mechanism-Driven and Clinically Focused Development of Botanical Foods as Multitarget Anticancer Medicine: Collective Perspectives and Insights from Preclinical Studies, IND Applications and Early-Phase Clinical Trials. Cancers (Basel) 2023; 15:701. [PMID: 36765659 PMCID: PMC9913787 DOI: 10.3390/cancers15030701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Cancer progression and mortality remain challenging because of current obstacles and limitations in cancer treatment. Continuous efforts are being made to explore complementary and alternative approaches to alleviate the suffering of cancer patients. Epidemiological and nutritional studies have indicated that consuming botanical foods is linked to a lower risk of cancer incidence and/or improved cancer prognosis after diagnosis. From these observations, a variety of preclinical and clinical studies have been carried out to evaluate the potential of botanical food products as anticancer medicines. Unfortunately, many investigations have been poorly designed, and encouraging preclinical results have not been translated into clinical success. Botanical products contain a wide variety of chemicals, making them more difficult to study than traditional drugs. In this review, with the consideration of the regulatory framework of the USFDA, we share our collective experiences and lessons learned from 20 years of defining anticancer foods, focusing on the critical aspects of preclinical studies that are required for an IND application, as well as the checkpoints needed for early-phase clinical trials. We recommend a developmental pipeline that is based on mechanisms and clinical considerations.
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Affiliation(s)
- Xiaoqiang Wang
- Department of Cancer Biology & Molecular Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Yin S. Chan
- Department of Cancer Biology & Molecular Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Kelly Wong
- Department of Cancer Biology & Molecular Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Ryohei Yoshitake
- Department of Cancer Biology & Molecular Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - David Sadava
- Department of Cancer Biology & Molecular Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Timothy W. Synold
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Paul Frankel
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Przemyslaw W. Twardowski
- Department of Urologic Oncology, Saint John’s Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA
| | - Clayton Lau
- Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Shiuan Chen
- Department of Cancer Biology & Molecular Medicine, Beckman Research Institute, City of Hope, 1500 E. Duarte Rd., Duarte, CA 91010, USA
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10
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Stramazzo I, Capriello S, Antonelli A, Fallahi P, Centanni M, Virili C. Seeking optimization of LT4 treatment in patients with differentiated thyroid cancer. Hormones (Athens) 2022; 21:537-543. [PMID: 35655116 PMCID: PMC9712340 DOI: 10.1007/s42000-022-00376-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
Levothyroxine sodium (LT4) is the mainstay treatment to replace thyroid hormonal production in thyroidectomized patients, but, depending on the aggressiveness of the cancer and on the risk of recurrence, patients with differentiated thyroid cancer may also be treated in a TSH-suppressive or semi-suppressive mode. The pathophysiological rationale for this LT4 treatment stems from the role of TSH, considered to be a growth factor for follicular cells, potentially inducing initiation or progression of follicular cell-derived thyroid cancer. Therefore, accurate tailoring of treatment, taking into account both patient characteristics (age and comorbidities) and risk of persistent/recurrent disease, is highly recommended. Furthermore, adjustments to traditional LT4 treatment should be made in thyroidectomized patients due to the lack of thyroidal contribution to whole body triiodothyronine (T3) concentration. Since LT4 exhibits a narrow therapeutic index and the side effects of over- and under-treatment could be deleterious, particularly in this category of patients, caution is required in dose individualization, in the mode of ingestion, and in potential pharmacological and other types of interference as well. Our aim was to analyze the current knowledge concerning LT4 dose requirements in patients with thyroid cancer according to different therapeutic approaches, taking into account a number of factors causing interference with LT4 efficacy. Specific mention is also made about the use of the novel LT4 formulations.
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Affiliation(s)
- Ilaria Stramazzo
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy
- Endocrine Unit, AUSL Latina, Latina, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy.
- Endocrine Unit, AUSL Latina, Latina, Italy.
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy
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11
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Baud G, Jannin A, Marciniak C, Chevalier B, Do Cao C, Leteurtre E, Beron A, Lion G, Boury S, Aubert S, Bouchindhomme B, Vantyghem MC, Caiazzo R, Pattou F. Impact of Lymph Node Dissection on Postoperative Complications of Total Thyroidectomy in Patients with Thyroid Carcinoma. Cancers (Basel) 2022; 14:cancers14215462. [PMID: 36358878 PMCID: PMC9657404 DOI: 10.3390/cancers14215462] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/15/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background: Lymph node dissection (LND) in primary treatment of differentiated thyroid carcinoma is controversial. The aim of our retrospective study was to analyse the risk factors of post-thyroidectomy complications and to assess the morbidity of lymph node dissection, especially in the central neck compartment, since prophylactic central lymph node dissection has not been proven to bring an overall survival benefit. Methods: We performed a retrospective analysis of postoperative complications from 1547 consecutive patients with differentiated thyroid carcinoma in an academic department of endocrine surgery over a period of 10 years. Results: A total of 535 patients underwent lymph node dissection, whereas the other 1012 did not. The rate of postoperative hypoparathyroidism was higher in patients with LND (17.6% vs. 11.4%, p = 0.001). No significant difference in the rate of permanent hypoparathyroidism (2.4% vs. 1.3%, p = 0.096) was observed between these two groups. A multivariate analysis was performed. Female gender, ipsilateral and bilateral central LND (CLND), parathyroid autotransplantation, and the presence of the parathyroid gland on the resected thyroid were associated with transient hypoparathyroidism. Bilateral CLND and the presence of the parathyroid gland on specimen were associated with permanent hypoparathyroidism. The rate of transient recurrent laryngeal nerve (RLN) injury (15.3% vs. 5.4%, p < 0.001) and permanent RLN injury (6.5% vs. 0.9%, p < 0.001) were higher in the LND group. In multivariate analysis, ipsilateral and bilateral lateral LND (LLND) were the main predictive factors of transient and permanent RLN injury. Bilateral RLN injury (2.6% vs. 0.4%, p < 0.001), chyle leakage (2.4% vs. 0%, p < 0.001), other nerve injuries (2.2% vs. 0%, p < 0.001), and abscess (2.4% vs. 0.5%, p = 0.001) were higher in the patients with LND. Conclusions: The surgical technique and the extent of lymph node dissection during surgery for thyroid carcinoma increase postoperative morbidity. A wider knowledge of lymph-node-dissection-related complications associated with thyroid surgery could help surgeons to carefully evaluate the surgical and medical therapeutic options.
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Affiliation(s)
- Gregory Baud
- Department of Endocrine Surgery, CHU Lille, F-59000 Lille, France
| | - Arnaud Jannin
- Department of Endocrinology and Metabolism, CHU Lille, F-59000 Lille, France
| | | | - Benjamin Chevalier
- Department of Endocrinology and Metabolism, CHU Lille, F-59000 Lille, France
| | - Christine Do Cao
- Department of Endocrinology and Metabolism, CHU Lille, F-59000 Lille, France
| | | | - Amandine Beron
- Department of Nuclear Medicine, CHU Lille, F-59000 Lille, France
| | - Georges Lion
- Department of Nuclear Medicine, CHU Lille, F-59000 Lille, France
| | - Samuel Boury
- Department of Radiology, CHU Lille, F-59000 Lille, France
| | - Sebastien Aubert
- Pathology Institute, Biology Pathology Center, CHU Lille, F-59000 Lille, France
| | | | | | - Robert Caiazzo
- Department of Endocrine Surgery, CHU Lille, F-59000 Lille, France
| | - François Pattou
- Department of Endocrine Surgery, CHU Lille, F-59000 Lille, France
- Correspondence: ; Tel.: +33-(0)3-20-62-69-63; Fax: +33-(0)3-20-62-69
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12
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Graupera I, Thiele M, Serra-Burriel M, Caballeria L, Roulot D, Wong GLH, Fabrellas N, Guha IN, Arslanow A, Expósito C, Hernández R, Aithal GP, Galle PR, Pera G, Wong VWS, Lammert F, Ginès P, Castera L, Krag A. Low Accuracy of FIB-4 and NAFLD Fibrosis Scores for Screening for Liver Fibrosis in the Population. Clin Gastroenterol Hepatol 2022; 20:2567-2576.e6. [PMID: 34971806 DOI: 10.1016/j.cgh.2021.12.034] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fibrosis-4 (FIB-4) and the nonalcoholic fatty liver disease fibrosis score (NFS) are the 2 most popular noninvasive blood-based serum tests proposed for widespread fibrosis screening. We therefore aimed to describe the accuracy of FIB-4 and NFS to detect elevated liver stiffness as an indicator of hepatic fibrosis in low-prevalence populations. METHODS This study included a total of 5129 patients with concomitant measurement of FIB-4, NFS, and liver stiffness measurement (LSM) by Fibroscan (Echosens, France) from 5 independent population-based cohorts from Spain, Hong Kong, Denmark, England, and France; 3979 participants from the general population and 1150 from at-risk cohorts due to alcohol, diabetes, or obesity. We correlated LSM with FIB-4 and NFS, and calculated pre- and post-test predictive values of FIB-4 and NFS to detect elevated LSM at 8 kPa and 12 kPa cutoffs. The mean age was 53 ± 12 years, the mean body mass index was 27 ± 5 kg/m2, and 2439 (57%) were women. One in 10 patients (552; 11%) had liver stiffness ≥8 kPa, but 239 of those (43%) had a normal FIB-4, and 171 (31%) had normal NFS. The proportion of false-negatives was higher in at-risk patients than the general population. FIB-4 was false-negative in 11% of diabetic subjects, compared with 2.5% false-negatives with NFS. Waist circumference outperformed FIB-4 and NFS for detecting LSM ≥8 kPa in the general population. Almost one-third (28%-29%) of elevated FIB-4/NFS were false-positive in both the general population and at-risk cohorts. CONCLUSIONS FIB-4 and NFS are suboptimal for screening purposes due to a high risk of overdiagnosis and a non-negligible percentage of false-negatives, especially in patients with risk factors for chronic liver disease. Waist circumference emerged as a potential first step to identify patients at risk for liver fibrosis in the general population.
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Affiliation(s)
- Isabel Graupera
- Liver Unit Hospital Clínic. Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Department for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Llorenç Caballeria
- USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Dominique Roulot
- Department of Hepatology, AP-HP, Hopital Avicenne, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona; Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Anita Arslanow
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Carmen Expósito
- USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Rosario Hernández
- CAP La Marina, Institut Català de la Salut de Barcelona, Barcelona, Spain
| | - Guruprasad Padur Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Guillem Pera
- USR Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Pere Ginès
- Liver Unit Hospital Clínic. Institut D'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Laurent Castera
- Hôpital Beaujon; Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France; Université Paris VII, Inserm Umr 1149, Centre de Recherche Sur L'inflammation, Paris, France
| | - Aleksander Krag
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Department for Clinical Research, University of Southern Denmark, Odense, Denmark
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13
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Koelker M, Krimphove M, Alkhatib K, Nabi J, Kuo LE, Lipsitz SR, Choueiri TK, Chang SL, Doherty GM, Kibel AS, Trinh QD, Cole AP. Understanding Hospital-Level Patterns of Nonoperative Management for Low-risk Thyroid and Kidney Cancer. JAMA Netw Open 2022; 5:e2242210. [PMID: 36378306 PMCID: PMC9667332 DOI: 10.1001/jamanetworkopen.2022.42210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE There is a growing trend toward conservative management for certain low-risk cancers. Hospital and health-system factors may play a role in determining how these patients are managed. OBJECTIVE To explore the contribution of hospitals on patients' odds of nonoperative management for low-risk cancer. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, individuals with low-risk papillary thyroid cancer and solitary kidney masses were identified, and those receiving nonoperative management vs surgery were compared. Patients with low-risk thyroid cancer and kidney cancer from 2015 to 2017 eligible for nonoperative management according to National Comprehensive Cancer Network guidelines within the National Cancer Database were included. Data were analyzed from October 2021 to March 2022. MAIN OUTCOMES AND MEASURES For each facility, the proportion of these patients who received operative and nonoperative management was calculated. A mixed-effects logistic regression model with a hospital-level random effects term was used to calculate factors associated with nonoperative management. Between-hospital variability was assessed using ranked caterpillar plots. RESULTS There were 19 570 individuals with low-risk thyroid cancer (15 344 women [78.4%]; mean [SD] age, 51.74 [95% CI, 51.39-52.08] years) and 41 403 with kidney cancer (25 253 men [61.0%]; mean [SD] age, 61.93 [95% CI, 61.70-62.17] years). In the group with low-risk thyroid cancer, 2.1% (419 patients) received nonoperative management, and in the group with kidney cancer, 9.5% (3928 patients) received nonoperative management. This varied between hospitals from 1.1% (95% CI, 1.0%-1.1%) in the bottom decile to 10.3% (95% CI, 8.0%-12.4%) in the top decile for low-risk thyroid cancer, and from 4.3% (95% CI, 4.1%-4.4%) in the bottom decile to 24.6% (95% CI, 22.7%-26.5%) in the top decile for small kidney masses. For both cancers, age was associated with increased odds of nonoperative treatment. The hospital-level odds of nonoperative management of thyroid and kidney cancer using unadjusted probabilities (observed proportions) were minimally correlated (Spearman ρ = .33; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that although health systems factors may be associated with the tendency to pursue nonoperative management, hospital-level factors may differ when comparing unrelated cancers.
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Affiliation(s)
- Mara Koelker
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marieke Krimphove
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Khalid Alkhatib
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Junaid Nabi
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lindsay E. Kuo
- Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Stuart R. Lipsitz
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Steven Lee Chang
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gerard M. Doherty
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Alexander P. Cole
- Center of Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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14
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Wei J, Thwin M, Nickel B, Glover A. Factors That Inform Individual Decision Making Between Active Surveillance, Hemithyroidectomy and Total Thyroidectomy for Low-Risk Thyroid Cancer: A Scoping Review. Thyroid 2022; 32:807-818. [PMID: 35438545 DOI: 10.1089/thy.2021.0646] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Due to the excellent prognosis and relatively high incidence of small low-risk thyroid cancers, more conservative management strategies such as active surveillance (AS) or hemithyroidectomy (HT) may be preferable to total thyroidectomy (TT) for patients seeking to balance long-term survival rates with the potential adverse effects of overtreatment. The aim of this review was to synthesize key factors or variables that inform patient decision making about treatment for low-risk thyroid cancer, from current primary investigations that presented participants with information facilitating this choice. Methods: Studies were identified from the Medline, Cochrane, and Embase databases up until March 2022. Study characteristics were extracted into a pre-piloted form. Factors were hypothesized to include treatment-related risks and possible outcomes and identified from a review of studies with consensus by discussion. Results: The search identified 444 unique studies: 397 were excluded on review of abstract and title with 47 studies undergoing a full text review and 6 studies identified to be eligible. Four were cross-sectional: one a prospective cohort study and one a mixed-methods study with both a prospective observational and qualitative component. The decisions addressed included: the choice between AS versus surgery (HT and/or TT) and HT versus TT and enrolled participants ranging from healthy volunteers to thyroid cancer patients. Treatment choice was the primary outcome in five studies. Across the studies, participants who were given the option of AS or surgery predominately chose the more conservative pathway, with a range of 70-84%. The major factors represented by information provision in the studies were risk of cancer recurrence or spread, need for hormone replacement therapy, and voice change. Conclusions: A framework of key factors informing patient treatment choice may be derived from current studies involving information provision for low-risk thyroid cancer management. Further research evaluating the efficacy and optimal timing for decision support interventions would help inform the design and clinical use of these tools to promote shared decision making.
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Affiliation(s)
- Jessica Wei
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - May Thwin
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney and Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anthony Glover
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
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15
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Hughes DT, Reyes-Gastelum D, Ward KC, Hamilton AS, Haymart MR. Barriers to the Use of Active Surveillance for Thyroid Cancer Results of a Physician Survey. Ann Surg 2022; 276:e40-e47. [PMID: 33074908 PMCID: PMC8549720 DOI: 10.1097/sla.0000000000004417] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to determine physician-reported use of and barriers to active surveillance for thyroid cancer. SUMMARY BACKGROUND DATA It is not clear whether active surveillance for thyroid cancer is widely used. METHODS Surgeons and endocrinologists identified by thyroid cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County were surveyed between 2018 and 2019. Multivariable weighted logistic regression analyses were conducted to determine physician acceptance and use of active surveillance. Results: Of the 654 eligible physicians identified, 448 responded to the survey (69% response rate). The majority (76%) believed that active surveillance was an appropriate management option, but only 44% used it in their practice. Characteristics of physicians who stated that active surveillance was appropriate management, but did not report using it included more years in practice (reference group <10 years in practice): 10 to 19 years [odds ratio, OR 0.50 [95% confidence interval, CI 0.28-0.92]; 20 to 29 years [OR 0.31 (95% CI 0.15-0.62)]; >30 years [OR 0.30 (95% CI 0.15-0.61)] and higher patient volume 11 to 30 patients per year [OR 0.39 (95% CI 0.21 -0.70)] and >50 patients per year [OR 0.33 (95% CI 0.16-0.71)] compared to < 10, with no significant difference in those seeing 31 to 50 patients. Physicians reported multiple barriers to implementing active surveillance including patient does not want (80.3%), loss to follow-up concern (78.4%), more patient worry (57.6%), and malpractice lawsuit concern (50.9%). CONCLUSION AND RELEVANCE Despite most physicians considering active surveillance to be appropriate management, more than half are not using it. Addressing existing barriers is key to improving uptake.
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Affiliation(s)
- David T Hughes
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - David Reyes-Gastelum
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Megan R Haymart
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
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16
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Eymech O, Brunckhorst O, Fox L, Jawaid A, Van Hemelrijck M, Stewart R, Dasgupta P, Ahmed K. An exploration of wellbeing in men diagnosed with prostate cancer undergoing active surveillance: a qualitative study. Support Care Cancer 2022; 30:5459-5468. [PMID: 35304633 PMCID: PMC8933126 DOI: 10.1007/s00520-022-06976-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. METHODS Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. RESULTS Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an 'Emotional Diagnostic Disequilibrium'. Informational awareness and education about prostate cancer helped patients with 'Recognition of the Impact'. Patients experienced an 'Unsettling Monitoring Cycle' due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is 'A Future Problem'. 'Concealment of Diagnosis' left many feeling isolated and highlighted an important coping mechanisms in the 'Importance of a Social Support Network' theme. Finally, physical health mostly changed through alterations in health behaviour, leading to 'A Healthier Lifestyle' with increasing attribution of physical symptoms to age through 'Symptomatic Overshadowing'. CONCLUSION The greatest disease impact on men's wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.
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Affiliation(s)
- Omar Eymech
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.
| | - Louis Fox
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anam Jawaid
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
- Urology Centre, Guy's and St, Thomas' NHS Foundation Trust, King's Health Partners London, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
- Department of Urology, King's College Hospital, London, UK
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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17
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Chou R, Dana T, Haymart M, Leung AM, Tufano RP, Sosa JA, Ringel MD. Active Surveillance Versus Thyroid Surgery for Differentiated Thyroid Cancer: A Systematic Review. Thyroid 2022; 32:351-367. [PMID: 35081743 PMCID: PMC11265616 DOI: 10.1089/thy.2021.0539] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Active surveillance has been proposed as an appropriate management strategy for low-risk differentiated thyroid cancer (DTC), due to the typically favorable prognosis of this condition. This systematic review examines the benefits and harms of active surveillance vs. immediate surgery for DTC, to inform the updated American Thyroid Association guidelines. Methods: A search on Ovid MEDLINE, Embase, and Cochrane Central was conducted in July 2021 for studies on active surveillance vs. immediate surgery. Studies of surgery vs. no surgery for DTC were assessed separately to evaluate relevance to active surveillance. Quality assessment was performed, and evidence was synthesized narratively. Results: Seven studies (five cohort studies [N = 5432] and two cross-sectional studies [N = 538]) of active surveillance vs. immediate surgery, and seven uncontrolled treatment series of active surveillance (N = 1219) were included. One cross-sectional study was rated fair quality, and the remainder were rated poor quality. In patients with low risk (primarily papillary), small (primarily ≤1 cm) DTC, active surveillance, and immediate surgery were associated with similar, low risk of all-cause or cancer-specific mortality, distant metastasis, and recurrence after surgery. Uncontrolled treatment series reported no cases of mortality in low-risk DTC managed with active surveillance. Among patients managed with active surveillance, rates of tumor growth were low; rates of subsequent surgery varied and primarily occurred due to patient preference rather than tumor progression. Four cohort studies (N = 88,654) found that surgery associated with improved all-cause or thyroid cancer mortality compared with nonsurgical management, but findings were potentially influenced by patient age and tumor risk category and highly susceptible to confounding by indication; eligibility for, and receipt of, active surveillance; and timing of surgery was unclear. Conclusions: In patients with small low-risk (primarily papillary) DTC, active surveillance and immediate surgery may be associated with similar mortality, risk of recurrence, and other outcomes, but methodological limitations preclude strong conclusions. Studies of no surgery vs. surgery are difficult to interpret due to clinical heterogeneity and potential confounding factors and are unsuitable for assessing the utility of active surveillance. Research is needed to clarify the benefits and harms of active surveillance and determine outcomes in nonpapillary DTC, larger (>1 cm) cancers, and older patients.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Tracy Dana
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Megan Haymart
- Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ralph P. Tufano
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Matthew D. Ringel
- Divison of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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18
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Ellsworth BL, Metz AK, Mott NM, Kazemi R, Stover M, Hughes T, Dossett LA. Review of Cancer-Specific Quality Measures Promoting the Avoidance of Low-Value Care. Ann Surg Oncol 2022; 29:3750-3762. [DOI: 10.1245/s10434-021-11303-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/18/2021] [Indexed: 12/28/2022]
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19
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A web-based personalized decision support tool for patients diagnosed with ductal carcinoma in situ: development, content evaluation, and usability testing. Breast Cancer Res Treat 2022; 192:517-527. [PMID: 35107714 DOI: 10.1007/s10549-022-06512-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Patients diagnosed with ductal carcinoma in situ (DCIS) face trade-offs when deciding among different treatments, including surgery, radiation, and endocrine therapy. A less chosen option is active monitoring. While evidence from clinical trials is not yet available, observational studies show comparable results for active monitoring and immediate treatment on cancer outcomes in select subgroups of patients. We developed and tested a web-based decision support tool (DST) to help patients explore current knowledge about DCIS and make an informed choice. METHODS The DST, an interactive web application, was informed by literature reviews and formative work with patients, breast surgeons, and health communication experts. We conducted iterative interviews to evaluate the DST content among women with and without a history of breast cancer, as well as breast cancer experts. For usability testing, we conducted an online survey among women with and without a history of breast cancer. RESULTS For content evaluation, 5 women with and 10 women without a history of DCIS were interviewed. The sample included 11 White and 4 non-White women, with a mean age of 64 years. The expert sample consisted of 5 attendings and a physician assistant. The feedback was used to add, clarify, or reorganize information in the DST. For usability testing, 22 participants with a mean age of 61 years were recruited including 15 White and 7 Black women and 6 women with a history of DCIS. The mean usability score was 3.7 out of 5. Most participants (86%) found that the DST provided unbiased information about treatments. To improve usability, we reduced the per-page content and added navigation cues. CONCLUSION Content and usability evaluation showed that the DST helps patients explore trade-offs of active monitoring and immediate treatment. By adopting a personalized approach, the tool will enable informed decisions aligned with patients' values and expectations.
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Payne RG, Anker CJ, Sprague BL, No HJ, Lin SH, Lester-Coll NH. Active Surveillance for Early Stage Lung Cancer. Clin Lung Cancer 2022; 23:226-235. [DOI: 10.1016/j.cllc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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21
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Tuffour I. Let's talk about the negative experiences of Black mental health service users in England: Now is the moment to consider watchful waiting to support their recovery. Nurs Inq 2021; 29:e12484. [DOI: 10.1111/nin.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Isaac Tuffour
- School of Nursing, Faculty of Education, Health, and Wellbeing University of Wolverhampton Wolverhampton UK
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22
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Akpan E, Kitundu J, Ekpo E. Public Health Radiography: A Scoping Review of Benefits, and Growth Opportunities for Radiographers. J Med Imaging Radiat Sci 2021; 52:615-625. [PMID: 34531164 DOI: 10.1016/j.jmir.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 06/17/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is growing adoption of radiographic techniques in public health to improve outcomes of chronic and communicable diseases. This review examines the applications, benefits, and implications of radiography in public health. It also examines the challenges and potential advanced practice roles for radiographers in public health radiography (PHR). METHODOLOGY Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping review extension (PRISMA- ScR) checklist was employed, and the search was conducted using PubMed, Medline, Web of Science, ScienceDirect, and Google Scholar to identify relevant articles that explored the concept of radiography in public health. Evidence was analysed using an inductive iterative approach. RESULTS Radiographic imaging modalities such as ultrasound, computed tomography, and plain X-ray had wide applicability in public health fields of preventive cardiology, preventive oncology, maternal health, infectious disease epidemiology, and radiographic informatics. PHR effectively reduced mortality, improved outcomes, informed lifestyle changes to mitigate the risk of impending disease. PHR also helped in monitoring disease progression and predicting treatment outcomes. However, evidence establishing a competency framework that supports PHR is scarce. CONCLUSION Radiography makes a significant contribution to public health in reducing mortality and morbidity. Therefore, developing a PHR competency framework can accentuate the contribution Radiographers make to solving public health issues.
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Affiliation(s)
- Eyo Akpan
- Grayscale International Ltd, Lagos, Nigeria.
| | - Jane Kitundu
- Vijibweni District Hospital, Kigamboni Municipal, Dar es Salaam, Tanzania
| | - Ernest Ekpo
- Image Optimisation and Perception Group, Discipline of Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Cumberland Campus C42
- 75 East Street, Lidcombe, NS, W
- 2141
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Johnson A, Shukla N, Halley M, Nava V, Budaraju J, Zhang L, Linos E. Barriers and facilitators to mobile health and active surveillance use among older adults with skin disease. Health Expect 2021; 24:1582-1592. [PMID: 34190397 PMCID: PMC8483196 DOI: 10.1111/hex.13229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic has accelerated the adoption of telemedicine, including teledermatology. Monitoring skin lesions using teledermatology may become increasingly important for several skin diseases, including low‐risk skin cancers. The purpose of this study was to describe the key factors that could serve as barriers or facilitators to skin disease monitoring using mobile health technology (mHealth) in older adults. Methods Older adult dermatology patients 65 years or older and their caregivers who have seen a dermatologist in the last 18 months were interviewed and surveyed between December 2019 and July 2020. The purpose of these interviews was to better understand attitudes, beliefs and behaviours that could serve as barriers and facilitators to the use of mHealth and active surveillance to monitor low‐risk skin cancers. Results A total of 33 interviews leading to 6022 unique excerpts yielded 8 factors, or themes, that could serve as barriers, facilitators or both to mHealth and active surveillance. We propose an integrated conceptual framework that highlights the interaction of these themes at both the patient and provider level, including care environment, support systems and personal values. Discussion and conclusions These preliminary findings reveal factors influencing patient acceptance of active surveillance in dermatology, such as changes to the patient‐provider interaction and alignment with personal values. These factors were also found to influence adoption of mHealth interventions. Given such overlap, it is essential to address barriers and facilitators from both domains when designing a new dermatology active surveillance approach with novel mHealth technology. Patient or public contribution The patients included in this study were participants during the data collection process. Members of the Stanford Healthcare and Denver Tech Dermatology health‐care teams aided in the recruitment phase of the data collection process.
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Affiliation(s)
- Austin Johnson
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Neha Shukla
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Meghan Halley
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA.,School of Medicine, Center for Biomedical Ethics, Stanford University, Stanford, CA, USA
| | - Vanessa Nava
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Janya Budaraju
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Lucy Zhang
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
| | - Eleni Linos
- Department of Dermatology, School of Medicine, Program for Clinical Research and Technology, Stanford University, Stanford, CA, USA
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Herb J, Ollila DW, Hollis A, O'Shea K, Googe P, Stitzenberg K. The Difficult Reality of Active Surveillance and the Urgent Need for Ongoing Research. Ann Surg Oncol 2021; 29:42-44. [PMID: 34120267 DOI: 10.1245/s10434-021-10305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Joshua Herb
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David W Ollila
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Hollis
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristin O'Shea
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Googe
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karyn Stitzenberg
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lincango-Naranjo E, Solis-Pazmino P, El Kawkgi O, Salazar-Vega J, Garcia C, Ledesma T, Rojas T, Alvarado-Mafla B, Young G, Dy B, Ponce OJ, Brito JP. Triggers of thyroid cancer diagnosis: a systematic review and meta-analysis. Endocrine 2021; 72:644-659. [PMID: 33512656 DOI: 10.1007/s12020-020-02588-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Understanding the method of thyroid cancer detection has potential implications on interpreting incidence rates, the diagnosis and management of thyroid cancer. We conducted a systematic review of studies reporting methods of thyroid cancer detection to estimate the frequency of incidentally found cancers and classify triggers of incidental thyroid cancer diagnosis. METHODS We searched multiple bibliographic databases from inception to June 2020. A pair of reviewers, working independently and in duplicate selected studies for inclusion, extracted data, and evaluated each trial's risk of bias. Studies enrolling patients older than 18 years with thyroid cancer confirmed histologically were included. RESULTS In total, 17 cohorts and 1 cross-sectional study, conducted between 1991 and 2018, enrolling 4668 patients with thyroid cancer were included: 88% had papillary thyroid cancer and 23% had papillary thyroid microcarcinoma. The proportion of patients with non-incidental and incidental thyroid cancer was similar: 49% [95% confidence interval (CI): 40-58%]. Subgroup analysis showed that most patients with incidental thyroid cancers had tumor size <10 mm (76%; 95% CI: 56-92%), age >45 (61%; 95% CI: 56-67%), and were detected through imaging (35%; 95% CI: 26-45%), of which ultrasound was the most common modality (27%; 95% CI: 14-43%). The heterogeneity for all the effect sizes was large and significant. CONCLUSIONS About half of thyroid cancers were found incidentally through the use of imaging studies, in particular neck ultrasound. These incidentally found cancers were mostly small papillary thyroid cancer. These results highlight opportunities for interventions aimed at reducing drivers of overdiagnosis.
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Affiliation(s)
- Eddy Lincango-Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
| | - Paola Solis-Pazmino
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Omar El Kawkgi
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA
| | - Jorge Salazar-Vega
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Endocrinology Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Cristhian Garcia
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Surgery Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Tannya Ledesma
- Universidad Central, Medical School, Quito-Ecuador, Quito, Ecuador
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
| | - Tatiana Rojas
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Universidad San Francisco de Quito, Quito, Ecuador
| | | | | | - Benzon Dy
- Division of Endocrine Surgery, Mayo Clinic, Rochester, MN, USA
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
- CaTaLiNA: Cancer de tiroides en Latinoamerica, Quito, Ecuador.
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA.
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Radhakrishnan A, Wallner LP, Skolarus TA, Abrahamse PH, Kollipara AS, Katz SJ, Hawley ST. Primary Care Providers' Perceptions About Participating in Low-Risk Prostate Cancer Treatment Decisions. J Gen Intern Med 2021; 36:447-454. [PMID: 33123958 PMCID: PMC7878590 DOI: 10.1007/s11606-020-06318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary care provider's (PCP) role in cancer care is expanding and may include supporting patients in their treatment decisions. However, the degree to which PCPs engage in this role for low-risk prostate cancer is unknown. OBJECTIVE Characterize PCP perceptions regarding their role in low-risk prostate cancer treatment decision-making. DESIGN Cross-sectional, national survey. MAIN MEASURES For men with low-risk prostate cancer, PCP reports of (1) confidence in treatment decision-making (high vs. low); (2) intended participation in key aspects of active surveillance treatment decision-making (more vs. less). KEY RESULTS A total of 347 from 741 eligible PCPs responded (adjusted response rate 56%). Half of respondent PCPs (50.3%) reported high confidence about engaging in low-risk prostate cancer treatment decision-making. The odds of PCPs reporting high confidence were greater among those in solo practice (vs working with > 1 PCP) (OR 2.18; 95% CI 1.14-4.17) and with higher volume of prostate cancer patients (> 15 vs. 6-10 in past year) (OR 2.16; 95% CI 1.02-4.61). PCP report of their intended participation in key aspects of active surveillance treatment decision-making varied: discussing worry (62.4%), reviewing benefits (48.5%) and risks (41.8%), and reviewing all treatment options (34.2%). PCPs who reported high confidence had increased odds of more participation in all aspects of active surveillance decision-making: reviewing all treatment options (OR 3.11; 95% CI 1.82-5.32), discussing worry (OR 2.12; 95% CI 1.28-3.51), and reviewing benefits (OR 3.13; 95% CI 1.89-5.16) and risks (OR 3.20; 95% CI 1.91-5.36). CONCLUSIONS The majority of PCPs were confident about engaging with patients in low-risk prostate cancer treatment decision-making, though their intended participation varied widely across four key aspects of active surveillance care. With active surveillance being considered for other low-risk cancers (such as breast and thyroid), understanding factors influencing PCP involvement will be instrumental to supporting team-based cancer care.
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Affiliation(s)
| | - Lauren P Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Ted A Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Paul H Abrahamse
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Adam S Kollipara
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Steven J Katz
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
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Dodd RH, Cvejic E, Bell K, Black K, Bateson D, Smith MA, Mac OA, McCaffery KJ. Active surveillance as a management option for cervical intraepithelial neoplasia 2: An online experimental study. Gynecol Oncol 2021; 161:179-187. [PMID: 33516531 DOI: 10.1016/j.ygyno.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate framing of active surveillance as a management option for cervical intraepithelial neoplasia (CIN)2 in women of childbearing age. METHODS We conducted a between-subjects factorial (2 × 2) randomised experiment. Women aged 25-40 living in Australia were presented with the same hypothetical pathway of testing human papillomavirus (HPV)-positive, high-grade cytology and a diagnosis of CIN2, through an online survey. They were randomised to one of four groups to evaluate the effects of (i) framing (method of explaining resolution of abnormal cells) and (ii) inclusion of an overtreatment statement (included versus not). Primary outcome was management choice following the scenario: active surveillance or surgery. RESULTS 1638 women were randomised. Overall, preference for active surveillance was high (78.9%; n = 1293/1638). There was no effect of framing or providing overtreatment information, or their interaction, on management choice. After adjusting for intervention received, age, education, and other model covariates, participants were more likely to choose active surveillance over surgery if they had not already had children, had plans for children in the future, had no family history of cancer, had no history of endometriosis, had adequate health literacy, and more trust in their GP. Participants were less likely to choose active surveillance over surgery if they were more predisposed to seek health care for minor problems. CONCLUSIONS Although we found no framing effect across the four conditions, we found a high level of preference for active surveillance with associations of increased preference that accord with the desire to minimise potential risks of CIN2 treatment on obstetric outcomes. These are valuable data for future clinical trials of active surveillance for management of CIN2 in younger women of childbearing age. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12618002043213, 20/12/2018, prior to participant enrolment).
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Affiliation(s)
- Rachael H Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney 2006, Australia.
| | - Erin Cvejic
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Katy Bell
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2006, Australia; Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Deborah Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney 2006, Australia; Family Planning New South Wales, Sydney, NSW 2131, Australia
| | - Megan A Smith
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney 2006, Australia; Cancer Research Division, Cancer Council NSW, Sydney 2011, Australia
| | - Olivia A Mac
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney 2006, Australia
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Kaliszewski K, Diakowska D, Rzeszutko M, Nowak Ł, Aporowicz M, Wojtczak B, Sutkowski K, Rudnicki J. Risk factors of papillary thyroid microcarcinoma that predispose patients to local recurrence. PLoS One 2020; 15:e0244930. [PMID: 33382852 PMCID: PMC7775061 DOI: 10.1371/journal.pone.0244930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions. METHODS We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008-2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features. RESULTS Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32-15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97-5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002). CONCLUSIONS The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Rzeszutko
- Department of Pathomorphology, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Nowak
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Aporowicz
- Department of Surgery Didactics, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Lohia S, Gupta P, Curry M, Morris LGT, Roman BR. Life Expectancy and Treatment Patterns in Elderly Patients With Low-Risk Papillary Thyroid Cancer: A Population-Based Analysis. Endocr Pract 2020; 27:228-235. [PMID: 33779556 DOI: 10.1016/j.eprac.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/07/2020] [Accepted: 12/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Guidelines endorse active surveillance for low-risk papillary thyroid carcinoma (PTC), but this is not commonly utilized. Those with limited life expectancy due to age and comorbidity may be best suited for active surveillance given their higher likelihood of other-cause mortality compared to disease-specific mortality. METHODS Surveillance, epidemiology, and end results-Medicare was queried for patients >65 years with T1, N0, M0 PTC who received surgery. We evaluated the overall survival, disease-specific survival (DSS), and survival based on tumor size and extent of surgery (hemi- vs total thyroidectomy). We created a competing risk model to identify the cumulative incidence of other-cause mortality to define patient groups with life expectancies of less than 10 and 15 years. RESULTS A total of 3280 patients were included. The 20-year overall survival and DSS were 38.2% and 98.5%, respectively. DSS was comparable between patients based on tumor size and surgery. The cancer cohort had better survival compared to matched controls (P < .001). Life expectancy was less than 15 years for any patient aged >80 years regardless of Charlson comorbidity score (CCS ≥ 0) and any patient aged >70 years with CCS ≥ 1. Life expectancy was less than 10 years for any patient a >80 years with CCS ≥ 1 and aged >70 years with CCS ≥ 3. CONCLUSION Older patients with comorbidities have limited life expectancies but excellent DSS from low-risk PTC. Incorporating life expectancy into management decisions and guidelines would likely promote selection of less aggressive management for populations that are most suited for this approach.
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Affiliation(s)
- Shivangi Lohia
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York
| | - Piyush Gupta
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York
| | - Michael Curry
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York
| | - Luc G T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York
| | - Benjamin R Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York.
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Expression of Class III Beta-Tubulin Is Associated with Invasive Potential and Poor Prognosis in Thyroid Carcinoma. J Clin Med 2020; 9:jcm9123830. [PMID: 33256003 PMCID: PMC7760790 DOI: 10.3390/jcm9123830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Although American Thyroid Association guidelines offer a risk stratification scheme for thyroid cancer patients, there is a continuous need for more sophisticated biomarkers that can predict disease progression. In this study, we aim to evaluate the prognostic value of class III beta-tubulin (TUBB3) and uncover the relationship between TUBB3 and invasive potential in thyroid carcinoma. Immunohistochemistry (IHC) for TUBB3 and E-cadherin was performed on a total of 254 cases of thyroid cancer specimens. Tumor budding at the invasive margin was evaluated. In vitro functional studies were also performed; the protein and mRNA levels of TUBB3 were compared among the five cell types at baseline, with transwell invasion and after blocking of TUBB3 by shRNA. IHC revealed that the levels of TUBB3 were higher in conventional papillary carcinomas (cPTCs) and anaplastic thyroid carcinomas (ATCs). In univariate analysis, high tumor budding and TUBB3 expression were associated with inferior progression-free survival in cPTC. The results of a Western blot and RT-PCR agreed with the IHC finding. The results were further validated through data from The Cancer Genome Atlas database. Our results suggest that high expression of TUBB3 in thyroid carcinoma could predict invasive potential and possibly be linked with epithelial–mesenchymal transition.
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Kang HY, Kim I, Kim YY, Bahk J, Khang YH. Income differences in screening, incidence, postoperative complications, and mortality of thyroid cancer in South Korea: a national population-based time trend study. BMC Cancer 2020; 20:1096. [PMID: 33176753 PMCID: PMC7661203 DOI: 10.1186/s12885-020-07597-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The incidence of thyroid cancer (TC) has increased rapidly over the past few decades in Korea. This study investigated whether the TC epidemic has been driven by overdiagnosis. Methods We calculated the TC screening rate from mid-2008 through mid-2014, and the incidence, postoperative complication, and mortality rates of TC between 2006 and 2015, using data from the Korea Community Health Survey, the National Health Insurance Database, and the cause-of-death data of Statistics Korea. Trends in age-standardized rates of all indicators were examined, along with income gaps therein. Analyses were conducted for lung cancer and stroke as negative control outcomes. Results The incidence rate of TC increased from 46.6 per 100,000 to 115.0 per 100,000 between 2006 and 2012, and then decreased to 63.5 per 100,000 in 2015. Despite these remarkable changes in incidence, mortality did not fluctuate during the same period. High income was associated with high rates of screening, incidence, and postoperative complications, while low income showed an association with a high mortality rate. Analyses using negative control outcomes showed that high income was associated with low rates of both incidence and mortality, which contrasted with the patterns of TC. The recent decreases in TC incidence and postoperative complications, which reflect societal concerns about the overdiagnosis of TC, were more pronounced in high-income individuals than in low-income individuals. Conclusions The time trends in income gaps in screening, incidence, postoperative complications, and mortality of TC, as well as negative control outcomes, provided corroborating evidence of TC overdiagnosis in Korea. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07597-4.
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Affiliation(s)
- Hee-Yeon Kang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Ikhan Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Health Policy and Management, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, Republic of Korea
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea. .,Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Xu X, Zhu Z, Xu Y, Tian S, Jiang Y, Zhao H. Effects of zinc finger protein 403 on the proliferation, migration and invasion abilities of prostate cancer cells. Oncol Rep 2020; 44:2455-2464. [PMID: 33125130 PMCID: PMC7610322 DOI: 10.3892/or.2020.7786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Zinc finger protein 403 (ZFP403), located on human chromosome 17q12-21, is closely associated with the development of cancer. However, to date, there are a limited number of studies on the biological functions of this gene, particularly in prostate cancer (PCa). The results of the present study demonstrated that compared with normal tissues, the expression of ZFP403 was markedly lower in PCa tissues, as shown by the evaluation of the Gene Expression Profiling Interactive Analysis 2 database. The decreased expression of ZFP403 in PCa clinical tissues and cell lines was confirmed by immunohistochemistry, reverse transcription-quantitative PCR and western blot analysis. Using short harpin (sh)RNA inhibition, stably-silenced ZFP403 cell lines were then constructed by lentiviral transfection (LV-PC3-shRNA-1 and 2; LV-DU145-shRNA-1 and 2). The results revealed that the knockdown of ZFP403 in PCa cells promoted cellular proliferation, colony formation, migration and invasiveness in vitro. Moreover, the levels of tumor growth- and motility-related proteins were significantly altered after ZFP403-knockdown. A xenograft tumor model using nude mice was established to elucidate the role of ZFP403 in tumorigenesis in vivo. Tumor growth was significantly increased in mice injected with ZFP403-knockdown cells compared with the control mice. Overall, the findings of the present study demonstrate that ZFP403 functions as a tumor suppressor gene in PCa by affecting the proliferation, migration and invasiveness of PCa cells, suggesting its potential use as a clinical diagnostic marker.
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Affiliation(s)
- Xintong Xu
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 311402, P.R. China
| | - Zhihui Zhu
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 311402, P.R. China
| | - Yipeng Xu
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Shasha Tian
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 311402, P.R. China
| | - Yingjun Jiang
- Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Huajun Zhao
- College of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 311402, P.R. China
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Lee SE, Kim EK, Moon HJ, Yoon JH, Park VY, Han K, Kwak JY. Guideline Implementation on Fine-Needle Aspiration for Thyroid Nodules: Focusing on Micronodules. Endocr Pract 2020; 26:1017-1025. [PMID: 33471690 DOI: 10.4158/ep-2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/28/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We investigated patients who were referred to our institution after fine-needle aspiration (FNA) was performed at outside clinics to evaluate how many nodules satisfied the FNA indications of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and compare that to the number of thyroid nodules that satisfy the FNA indications of the American College of Radiology (ACR)-TIRADS and American Thyroid Association (ATA) guidelines. METHODS Between January 2018 and December 2018, 2,628 patients were included in our study. The included patients were those referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using a generalized linear model and generalized estimating equation. RESULTS The median size of the 2,628 thyroid nodules was 0.9 cm (range, 0.2 to 9.5 cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1 cm) according to the ACR-TIRADS, ATA guideline, and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) (P<.001). CONCLUSION Among patients referred for thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules.
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Affiliation(s)
- Si Eun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea..
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Baskin AS, Wang T, Berlin NL, Skolarus TA, Dossett LA. Scope and Characteristics of Choosing Wisely in Cancer Care Recommendations by Professional Societies. JAMA Oncol 2020; 6:1463-1465. [PMID: 32701128 PMCID: PMC7378871 DOI: 10.1001/jamaoncol.2020.2066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/21/2020] [Indexed: 11/14/2022]
Affiliation(s)
| | - Ton Wang
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Nicholas L. Berlin
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Ted A. Skolarus
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Urology, University of Michigan, Ann Arbor
| | - Lesly A. Dossett
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
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Abstract
Background: The incidence of thyroid carcinoma is growing worldwide. More than 50% of new malignant tumors are classified as classical papillary carcinomas in low-risk category with a low rate of recurrence and high long-term survival. Active surveillance is a strategy to control low-risk tumor evolution with the intention to avoid unnecessary treatments and maintain thyroid function. The aim of this study was to report a cohort of patients with thyroid nodules classified as Bethesda V-VI and who are under active surveillance in Colombia. Methods: A prospective cohort was assembled since January 2015. All patients had been evaluated clinically, biochemically with ultrasonography and fine needle aspiration biopsy previous to the first evaluation. Active surveillance was proposed to patients with asymptomatic low-risk carcinoma (<1.5 cm, encapsulated, without evidence of lymph node metastasis), independent of sex or age. The strategy included a specific discussion about the surgical option and expected risk of complications, risk of long-term thyroxine support, and the active surveillance strategy. The data on age, sex, reason for an ultrasound examination, ultrasound risk by American Thyroid Association (ATA) classification, size and volume of the nodule, reason to consider active surveillance and follow-up ultrasounds, and surgical decision were recorded prospectively. A Kaplan-Meier curve was constructed for the rate of growth and increase in volume of the nodule, growth >3 mm and increase in volume >50%, and need of operation. Results: One hundred two patients were analyzed. Seventy-five percent of patients had a nodule smaller than 1 cm. Only 24/102 (23%) nodules were classified as ATA low risk. Thirty-four of 102 (33.3%) nodules were classified as Bethesda VI and the others were Bethesda V. The median follow-up was 13.9 months, and 32.3% of patients had more than 24 months of follow-up. Only 11/102 (10.8%) nodules grew more than 3 mm and 26/102 (25.5%) nodules grew more than 50% in volume. 12.7% patients were submitted to surgery. The overall stability rate without growth >3 mm, without volume increase >50%, and without surgery at 24 months were 89.8%, 77.0%, and 85.5%, respectively Conclusions: Active surveillance is possible in developing Western countries with similar results to those provided by Asian and American authors.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y Cuello (CEXCA), Medellín, Colombia
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Savoca E, Torabi SJ, Kasle D, Mets E, Hajek M, Waldman EH. Pediatric thyroidectomies: A surgical subspecialty comparison. Int J Pediatr Otorhinolaryngol 2020; 132:109945. [PMID: 32070842 DOI: 10.1016/j.ijporl.2020.109945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aims to establish the typical population, safety, and outcomes of pediatric thyroidectomies, specifically identifying surgical complication rates. Furthermore, the study compares management and complication differences between the two specialties that most often manage these patients - Pediatric General Surgery and Otolaryngology. METHODS National Surgical Quality Improvement Program - Pediatrics (NSQIP-P) data between the years of 2012 and 2016 was reviewed and analyzed for patient characteristics, perioperative course and outcomes. Sub-group analysis was used to compare groups based on surgeon sub-specialty: Otolaryngology or Pediatric General Surgery. RESULTS The study identified 516 cases pediatric patients operated on by Pediatric Otolaryngology (229; 44.4%) and Pediatric General Surgery (287; 55.6%). Overall, rates of surgical and medical adverse events were low (1.2% and 0.7%, respectively). Upon univariate analysis, there were no differences between specialties in surgical adverse events (p = 1.000), medical adverse events (p = 0.196), reoperation (p = 0.505), or readmission (p = 0.262). Indication for surgery differed between specialties, with benign neoplasm more common in the Pediatric Otolaryngology group (48.9% vs. 35.2%), and thyrotoxicosis more common in the Pediatric General Surgery group (43.9% vs. 23.1%) (p < 0.001). Compared to cases done by Otolaryngology, Pediatric General Surgery was independently associated with a shorter operative time (B: -31.583 min [95% CI: -42.802 to -20.364]; p < 0.001). CONCLUSION Thyroidectomy in the pediatric population is a safe procedure with no differences in adverse outcomes noted when comparing Pediatric General Surgeons to Pediatric Otolaryngologists. Pediatric General Surgeons were observed to have a significantly shorter operative time.
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Affiliation(s)
- Emily Savoca
- Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Sina J Torabi
- Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - David Kasle
- Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Elbert Mets
- Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Hajek
- Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Erik H Waldman
- Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
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Liu Y, Wang Y, Zhao K, Li D, Chen Z, Jiang R, Wang X, He X. Lymph node metastasis in young and middle-aged papillary thyroid carcinoma patients: a SEER-based cohort study. BMC Cancer 2020; 20:181. [PMID: 32131769 PMCID: PMC7057480 DOI: 10.1186/s12885-020-6675-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) occurs frequently in young papillary thyroid carcinoma (PTC) patients, though the mortality rates are low. We aimed to analyze the relationship between age at diagnosis and LNM in PTC at a population level to elucidate the clinical behavior of PTC. METHODS Data of adult patients with surgically treated PTC and follicular thyroid carcinoma (FTC) were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to investigate the relationship between age and clinical characteristics by curve estimation. The adjusted odds ratio of age and LNM rate were determined. RESULTS A total of 50,347 PTC (48,166) and FTC (2181) (median age: 45 and 50 years, respectively) patients met the inclusion criteria; 44.5% of those with PTC (21,428) had LNM. Rank-sum test analysis indicated differences in distribution of age in LNM-positive and LNM-negative PTC. The relationship between age, tumor size and LNM showed a quadratic curve in PTC. The mean tumor diameter and LNM rate correlated linearly with age in 18-59-year-old patients. LNM rate decreased with age (R2 = 0.932, P < .0001), especially women (R2 = 0.951, P < .0001). CONCLUSION In young and middle-aged PTC patients, LNM may resolve spontaneously with delayed diagnosis and management. Active surveillance of low-risk PTC is justified.
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Affiliation(s)
- Yuanchao Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Yizeng Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Ke Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Dongyang Li
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Zuoyu Chen
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Ruoyu Jiang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Xiaoning Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China.
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Krajewska J, Kukulska A, Oczko-Wojciechowska M, Kotecka-Blicharz A, Drosik-Rutowicz K, Haras-Gil M, Jarzab B, Handkiewicz-Junak D. Early Diagnosis of Low-Risk Papillary Thyroid Cancer Results Rather in Overtreatment Than a Better Survival. Front Endocrinol (Lausanne) 2020; 11:571421. [PMID: 33123090 PMCID: PMC7573306 DOI: 10.3389/fendo.2020.571421] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
We are witnessing a rapid worldwide increase in the incidence of papillary thyroid carcinoma (PTC) in the last thirty years. Extensive implementation of cancer screening and wide availability of neck ultrasound or other imaging studies is the main reason responsible for this phenomenon. It resulted in a detection of a growing number of clinically asymptomatic PTCs, mainly low-risk tumors, without any beneficial impact on survival. An indolent nature of low-risk PTC, particularly papillary thyroid microcarcinoma (PTMC), and the excellent outcomes raise an ongoing discussion regarding the adequacy of treatment applied. The question of whether PTMC is overtreated or not is currently completed by another, whether PTMC requires any treatment. Current ATA guidelines propose less extensive preoperative diagnostics and, if differentiated thyroid cancer is diagnosed, less aggressive surgical approach and limit indications for postoperative radioiodine therapy. However, in intrathyroidal PTMCs in the absence of lymph node or distant metastases, active surveillance may constitute alternative management with a low progression rate of 1%-5% and without any increase in the risk of poorer outcomes related to delayed surgery in patients, in whom it was necessary. This review summarizes the current knowledge and future perspectives of active surveillance in low-risk PTC.
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Affiliation(s)
- Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
- *Correspondence: Jolanta Krajewska,
| | - Aleksandra Kukulska
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
- Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Malgorzata Oczko-Wojciechowska
- Department of Genetic and Molecular Diagnostics of Cancer, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Agnieszka Kotecka-Blicharz
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Katarzyna Drosik-Rutowicz
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
- Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Malgorzata Haras-Gil
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
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Decallonne B, Van den Bruel A, Macq G, Elaut N, De Schutter H. The Impact of Regional Variation in Clinical Practice on Thyroid Cancer Diagnosis: A National Population-Based Study. Eur Thyroid J 2020; 9:32-39. [PMID: 32071900 PMCID: PMC7024889 DOI: 10.1159/000504046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/08/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Regional variation in thyroid cancer incidence in Belgium, most pronounced for low risk cancer, was previously shown to be related to variation in clinical practice, with higher thyroid surgery rates and lower proportions of preoperative fine-needle aspiration (FNA) in regions with high thyroid cancer incidence (period 2004-2006). The objective of this study was to investigate regional thyroid cancer incidence variation in relation with variation in thyroid surgery threshold in a more recent Belgian thyroid cancer cohort. METHODS A population-based cohort of thyroid cancer patients that underwent a (near) total thyroidectomy in the period 2009-2011 (n = 2,329 patients) was identified and studied by linking data from the Belgian cancer registry and the Belgian health insurance companies, and case-by-case study of the pathology protocols. The execution of preoperative FNA and the thyroid resection specimen weight were compared between high and low thyroid cancer incidence regions. Thyroid weight in the pT1a-restricted group was studied as a proxy for surgical threshold for benign nodular goiter. Furthermore, time trend analyses were performed for the execution of FNA for the period 2004-2012. RESULTS Although a lower proportion of FNA in the high thyroid cancer incidence region persisted in the period 2009-2011 (41.2% [31.9-50.9] vs. 72.9% [64.9-79.7] in the low-incidence region (LIR), p < 0.001), a positive time trend was observed for the period 2004-2012. The median thyroid surgical specimen weight was lower in the high incidence region compared to the LIR (27.0 g [IQR 18.0-45.3] vs. 36.0 g [IQR 22.0-73.0], p < 0.0001), and this finding was corroborated in the pT1a-restricted group. CONCLUSION Interregional differences in use of FNA and surgical thyroid specimen weight are consistent with an inverse relation between thyroid cancer incidence and thyroid surgery threshold, carrying risk for overdiagnosis.
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Affiliation(s)
- Brigitte Decallonne
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- *Brigitte Decallonne, MD, PhD, Department of Endocrinology, University Hospitals Leuven, Herestraat 49, BE–3000 Leuven (Belgium), E-Mail
| | | | - Gilles Macq
- Department of Research, Belgian Cancer Registry, Brussels, Belgium
| | - Nathalie Elaut
- Department of Research, Belgian Cancer Registry, Brussels, Belgium
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Dood RL, Zhao Y, Armbruster SD, Coleman RL, Tworoger S, Sood AK, Baggerly KA. Defining Survivorship Trajectories Across Patients With Solid Tumors: An Evidence-Based Approach. JAMA Oncol 2019; 4:1519-1526. [PMID: 29860375 DOI: 10.1001/jamaoncol.2018.2761] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Survivorship involves a multidisciplinary approach to surveillance and management of comorbidities and secondary cancers, overseen by oncologists, surgeons, and primary care physicians. Optimal timing and coordination of care, however, is unclear and often based on arbitrary 5-year cutoffs. Objective To determine high- and low-risk periods for all tumor types that could define when survivorship care might best be overseen by oncologists and when to transition to primary care physicians. Design, Setting, and Participants In this pan-cancer, longitudinal, observational study, excess mortality hazard, calculated as an annualized mortality risk above a baseline population, was plotted over time. The time this hazard took to stabilize defined a high-risk period. The percent morality elevation above age- and sex-matched controls in the latter low-risk period was reported as a mortality gap. The US population-based Surveillance, Epidemiology, and End Results database defined the cancer population, and the US Census life tables defined controls. Incident cases of patients with cancer were separated into tumor types based on International Classification of Diseases for Oncology definitions. Exposures Population-level data on incident cancer cases was compared with the general US population. Main Outcomes and Measures Overall mortality and cause of death were reported on observed cancer cases. Results A total of 2 317 185 patients (median age, 63 years; 49.8% female) with 66 primary tumor types were evaluated. High-risk surveillance period durations ranged from less than 1 year (breast, prostate, lip, ocular, and parathyroid cancers) up to 19 years (unspecified gastrointestinal cancers). The annualized mortality gap, representing the excess mortality in the stable period, ranged from a median 0.26% to 9.33% excess annual mortality (thyroid and hypopharyngeal cancer populations, respectively). Cluster analysis produced 6 risk cluster groups: group 1, with median survival of 16.2 (5th to 95th percentile range [PR], 10.7-40.2) years and median high-risk period of 2.5 (PR, 0-5.0) years; group 2, 8.3 (PR, 5.1-23.3) and 2.5 (PR, 4.0-8.0) years; group 3, 2.8 (PR, 1.4-3.7) and 7.0 (PR, 6.0-11.1) years; group 4, 1.6 (PR, 1.5-1.8) and 6.0 (PR, 5.1-11.4) years; group 5, 0.8 (PR, 0.5-1.2) and 0.8 (PR, 0.5-1.2) years; and group 6, 0.5 (PR, 0.4-0.8) and 12.0 (PR, 9.3-12.9) years, respectively. Subanalyses of selected tumor types in these groups revealed that stratifying on stage and histologic type can change the risk cluster and guidance for care. Conclusions and Relevance These findings indicate that a standardized 5-year surveillance period is inadequate for some cancers while excessive for others. High-risk cancers require the most resources with the longest high-risk period, highest persistent baseline mortality risk, and longest period of primary cancer mortality, all arguing for longer follow-up with an oncologist in these cancers.
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Affiliation(s)
- Robert L Dood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Yang Zhao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston
| | - Shannon D Armbruster
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Shelley Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Keith A Baggerly
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston
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Sanabria A. Active Surveillance in Thyroid Microcarcinoma in a Latin-American Cohort. JAMA Otolaryngol Head Neck Surg 2019; 144:947-948. [PMID: 30178005 DOI: 10.1001/jamaoto.2018.1663] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia.,Centro de Excelencia en Cirugía de Cabeza y Cuello, CEXCA, Medellín, Colombia
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Nickel B, Barratt A, McGeechan K, Brito JP, Moynihan R, Howard K, McCaffery K. Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:867-874. [PMID: 30335875 DOI: 10.1001/jamaoto.2018.1272] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Given evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs), strategies are needed to promote the consideration of less invasive treatment options for patients with low-risk PTC. Objective To determine the association of treatment preferences and anxiety levels for PTC with the terminology used to describe the condition. Design, Setting, and Participants This randomized crossover study involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer. Between March 16, 2016, and July 26, 2016, participants accessed an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells. Participants were exposed to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies. Data analysis was conducted from September 1, 2016, to May 15, 2017. Main Outcomes and Measures Treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety. Results Of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years. A higher proportion of participants (108 [19.6%]) chose total thyroidectomy when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used. At first exposure, the papillary thyroid cancer terminology led 60 of 186 participants (32.3%) to choose surgery compared with 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first. After the first exposure, participants who viewed papillary thyroid cancer terminology reported significantly higher levels of anxiety (mean, 7.8 of 11 points) compared with those who viewed the papillary lesion (mean, 7.0 of 11 points; mean difference, -0.8; 95% CI, -1.3 to -0.3) or abnormal cells (mean, 7.3 of 11 points; mean difference, -0.5; 95% CI, -1.0 to 0.01). Overall, interest in active surveillance was high and higher levels of anxiety were reported by those who chose surgery, regardless of which terminology was viewed first (mean difference, 1.5; 95% CI, 1.0-1.9). Conclusions and Relevance Changing the terminology of small PTCs may be one strategy to reduce patients' anxiety levels and help them consider less invasive management options. To curtail overdiagnosis and overtreatment in PTC, other strategies may include providing balanced information about the risks and advantages of alternative treatments. Trial Registration anzctr.org.au Identifier: ACTRN12616000271404.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Ray Moynihan
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.,Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Kirsten Howard
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Galofré JC. The dilemma of papillary thyroid microcarcinoma management. To operate or not to operate, that is the question. ACTA ACUST UNITED AC 2019; 66:469-471. [PMID: 32565060 DOI: 10.1016/j.endinu.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Juan C Galofré
- Departamento de Endocnrinología y Nutrición Clínica Universidad de Navarra. Pamplona.
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44
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Wallner LP, Reyes-Gastelum D, Hamilton AS, Ward KC, Hawley ST, Haymart MR. Patient-Perceived Lack of Choice in Receipt of Radioactive Iodine for Treatment of Differentiated Thyroid Cancer. J Clin Oncol 2019; 37:2152-2161. [PMID: 31283406 PMCID: PMC6698919 DOI: 10.1200/jco.18.02228] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE For many patients with differentiated thyroid cancer, use of radioactive iodine (RAI) does not improve survival or reduce recurrence risk. Yet there is wide variation in RAI use, emphasizing the importance of understanding patient perspectives regarding RAI decision making. PATIENTS AND METHODS All eligible patients diagnosed with thyroid cancer from 2014 to 2015 from the Georgia and Los Angeles SEER registries were surveyed (N = 2,632; response rate, 63%). Patients in whom selective RAI use is recommended were included in this analysis (n = 1,319). Patients were asked whether they felt like they had a choice to receive RAI (yes or no), how strongly their physician recommended RAI (5-point Likert-type scale), whether they received RAI (yes or no), and how satisfied they were with their RAI decision (more [score of 4 or greater] v less). Multivariable, weighted logistic regression with multiple imputation was used to assess the associations between patient characteristics and perception of no RAI choice and between perception of no RAI choice with receipt of RAI and decision satisfaction. RESULTS More than half of respondents (55.8%) perceived they did not have an RAI choice, and the majority of patients (75.9%) received RAI. The odds of perceiving no RAI choice was greater among those whose physician strongly recommended RAI (adjusted odds ratio [OR], 1.56; 95% CI, 1.13 to 2.17). Patients who perceived they did not have an RAI choice were more likely to receive RAI (adjusted OR, 2.50; 95% CI, 1.64 to 3.82) and report lower decision satisfaction (adjusted OR, 2.31; 95% CI, 1.67 to 3.20). CONCLUSION Many patients did not feel they had a choice about whether to receive RAI. Patients who perceived they did not have a choice were more likely to receive RAI and report lower decision satisfaction, suggesting a need for more shared decision making to reduce overtreatment.
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Affiliation(s)
| | | | - Ann S. Hamilton
- University of Southern California Keck School of Medicine, Los Angeles, CA
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45
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Panato C, Serraino D, De Santis E, Forgiarini O, Angelin T, Bidoli E, Zanier L, Del Zotto S, Vaccarella S, Franceschi S, Dal Maso L. Thyroid cancer in Friuli Venezia Giulia, northeastern Italy: incidence, overdiagnosis, and impact of type of surgery on survival. TUMORI JOURNAL 2019; 105:296-303. [PMID: 30917766 DOI: 10.1177/0300891619839307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidence rates of thyroid cancer (TC) increased in the last decades worldwide. This study aimed to describe TC incidence in the Friuli Venezia Giulia (FVG) region, to estimate the quota of overdiagnosis, and to investigate the impact of surgery on long-term survival after TC diagnosis. METHODS TC cases reported to the FVG population-based cancer registry during 2002-2013, aged <85 years, were included. Age standardized rates (ASR) on the European population were computed, while proportion of TC overdiagnosis was estimated in comparison with expected age-specific incidence rates from published time series. Adjusted hazard ratios of death, with 95% confidence intervals, were also estimated. RESULTS During 2002-2013, 1701 TC cases were reported to the FVG cancer registry, with papillary TC (78.2%) as the most frequent histologic type. ASR increased from 12.4 to 16.5 in women and from 4.3 to 6.2 in men (+33.1% and +44.2%, respectively). Overdiagnosis was estimated as 79% of TC cases in women and 64% in men. Almost all TC cases (97.1%) underwent surgery, including 84.6% of women and 78.9% of men who underwent total thyroidectomy. Up to 10 years after TC diagnosis, the type of surgery did not appear to influence survival. CONCLUSIONS This study documented an increase in TC incidence in FVG in the last decade, with overdiagnosis accounting for a large proportion of TC diagnoses and total thyroidectomy in more than 80% of cases. These findings suggest reconsidering thyroid screening practice and aggressive therapeutic strategies, as recommended by new TC guidelines.
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Affiliation(s)
- Chiara Panato
- 1 Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Diego Serraino
- 1 Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Emilia De Santis
- 2 Friuli Venezia Giulia Cancer Registry, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Ornella Forgiarini
- 2 Friuli Venezia Giulia Cancer Registry, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Tiziana Angelin
- 1 Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Ettore Bidoli
- 1 Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Loris Zanier
- 3 Epidemiological Service, Azienda Regionale di Coordinamento per la Salute (ARCS), Udine, Italy
| | - Stefania Del Zotto
- 3 Epidemiological Service, Azienda Regionale di Coordinamento per la Salute (ARCS), Udine, Italy
| | | | - Silvia Franceschi
- 5 Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Luigino Dal Maso
- 1 Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Canter DJ, Reid J, Latsis M, Variano M, Halat S, Rajamani S, Gurtner KE, Sangale Z, Brawer M, Stone S, Bardot S. Comparison of the Prognostic Utility of the Cell Cycle Progression Score for Predicting Clinical Outcomes in African American and Non-African American Men with Localized Prostate Cancer. Eur Urol 2019; 75:515-522. [DOI: 10.1016/j.eururo.2018.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022]
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Dickey SL, Grayson CJ. The Quality of Life among Men Receiving Active Surveillance for Prostate Cancer: An Integrative Review. Healthcare (Basel) 2019; 7:E14. [PMID: 30678213 PMCID: PMC6473640 DOI: 10.3390/healthcare7010014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
Prostate cancer is very common among men in the United States. The current literature on active surveillance (AS) suggests that it is a promising treatment option for men with low-risk prostate cancer. The purpose of this manuscript is to provide a thorough integrative review regarding the effects of AS on the quality of life (QoL) of men with prostate cancer. Utilizing a methodological strategy, electronic databases were reviewed for empirical articles during the time frame of January 2006 to December 2016. A total of 37 articles met the inclusion criteria wherein 20 focused on the QoL among men only receiving AS and 16 reported QoL among men undergoing AS and other forms of treatment for prostate cancer. The review highlights the purpose, common instruments, race and ethnicity, and strengths and limitations of each article. The majority of articles indicated low levels of anxiety and depression and decreased incidences of bladder, bowel and sexual functioning among men undergoing AS in comparison to men who received other treatment modalities. The results indicated that additional research is needed to determine the QoL among men receiving AS on a longitudinal basis. The results support previous literature that indicated the positive impact of AS on low-risk prostate cancer.
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Affiliation(s)
- Sabrina L Dickey
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA.
| | - Ciara J Grayson
- College of Medicine, Florida State University, Tallahassee, FL 32306, USA.
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No HJ, Lester-Coll NH, Seward DJ, Sidiropoulos N, Gagne HM, Nelson CJ, Garrison GW, Kinsey CM, Lin SH, Anker CJ. Active Surveillance for Medically Inoperable Stage IA Lung Cancer in the Elderly. Cureus 2018; 10:e3472. [PMID: 30648024 PMCID: PMC6318089 DOI: 10.7759/cureus.3472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Treatment for stage IA lung cancer may be too aggressive an approach in elderly patients with competing co-morbidities. We report outcomes for those electing active surveillance (AS) and investigate factors that may predict indolent disease. Materials and methods Retrospective review was performed for 12 consecutive patients, ≥70 years old, with medically inoperable stage IA, T1N0M0 lung cancer and significant co-morbidities, who chose AS with radiation therapy (RT) reserved for clear disease progression. Collected data included Charlson-Deyo Comorbidity Index (CDCI) grades, histology, and tumor size changes. Volume doubling time (VDT) calculations used a modified Schwartz equation. Results Fifteen nodules underwent AS in 12 patients; three patients had more than one nodule. Median age of all patients was 78 (range, 71–85). All patients’ CDCI grades were ≥1, 7 were ≥2. Eleven of 12 patients were deemed to be at high-risk for falls. Twelve nodules in 12 patients were biopsied; adenocarcinoma the prevailing common (47%) histology. The median, one, two and three year patient freedom-from-RT values were 21.4 months (95% CI: 11.6-not reached), 81%, 43%, and 29%, respectively. Median VDT of treated vs. untreated nodules was 189 days (range, 62-infinite) vs. 1153 days (range, 504-infinite), respectively. No patient progressed regionally or distantly, and there have been no cancer-related deaths. Due to cardiovascular events, two patients died and one remains on hospice. Median duration of AS for those still continuing computed tomography (CT) surveillance is 35.1 months. Conclusion Selected elderly patients with stage IA lung cancer and significant co-morbidities may undergo AS without detriment in outcome. Prospective AS studies are warranted.
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Affiliation(s)
- Hyunsoo J No
- Radiation Oncology, Larner College of Medicine at the University of Vermont, Burlington, USA
| | | | - David J Seward
- Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont and the University of Vermont Health Network, Burlington, USA
| | - Nikoletta Sidiropoulos
- Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont and the University of Vermont Health Network, Burlington, USA
| | - Havaleh M Gagne
- Radiation Oncology, University of Vermont Cancer Center, Burlington, USA
| | - Carl J Nelson
- Radiation Oncology, University of Vermont Cancer Center, Burlington, USA
| | - Garth W Garrison
- Pulmonology and Critical Care Medicine, University of Vermont Medical Center, Burlington, USA
| | - C Matthew Kinsey
- Pulmonary and Critical Care Medicine, University of Vermont Medical Center, Burlington, USA
| | - Steven H Lin
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Kulasingam V, Diamandis EP. Introduction to the Special Collection—Beating Cancer with Early Detection: A Seasoned Idea with New Insights. J Appl Lab Med 2018; 3:155-158. [DOI: 10.1373/jalm.2018.027557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Vathany Kulasingam
- Department of Clinical Biochemistry, University Health Network, Toronto, Canada
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Kalager M, Wieszczy P, Lansdorp-Vogelaar I, Corley DA, Bretthauer M, Kaminski MF. Overdiagnosis in Colorectal Cancer Screening: Time to Acknowledge a Blind Spot. Gastroenterology 2018; 155:592-595. [PMID: 30076834 DOI: 10.1053/j.gastro.2018.07.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mette Kalager
- University of Oslo and Oslo University Hospital, Oslo, Norway and Harvard School of Public Health, Boston, Massachusetts
| | - Paulina Wieszczy
- Centre of Postgraduate Medical Education and The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | | | | | - Michael Bretthauer
- University of Oslo and Oslo University Hospital, Oslo, Norway and Frontier Science Foundation, Boston, Massachusetts
| | - Michal F Kaminski
- University of Oslo, Oslo, Norway and Centre of Postgraduate Medical Education and Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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