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Dralle H, Weber F, Machens A, Brandenburg T, Schmid KW, Führer-Sakel D. [Hemithyroidectomy or total thyroidectomy for low-risk papillary thyroid cancer? : Surgical criteria for primary and secondary choice of treatment in an interdisciplinary treatment concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:79-92. [PMID: 36121448 DOI: 10.1007/s00104-022-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
The increase in small intrathyroid papillary thyroid cancer (PTC) observed worldwide over the past two decades, with no increase in cancer-specific mortality, has challenged the previous concept of total thyroidectomy as a one-size-fits-all panacea. After exclusion of papillary microcarcinomas, a systematic review of 20 clinical studies published since 2002, which compared hemithyroidectomy (HT) to total thyroidectomy (TT), found comparable long-term oncological outcomes for low-risk papillary thyroid cancer (LRPTC) 1-4 cm in diameter, whereas postoperative complication rates were markedly lower for HT. To refine individual treatment plans, HT should be combined with ipsilateral central lymph node dissection and intraoperative frozen section analysis for staging. Based on recent evidence from studies and in consideration of individual risk factors, patients with LRPTC can be offered the concept of HT as an alternative to the standard TT. A prerequisite for the treatment selection and decision is a comprehensive patient clarification of the possible advantages and disadvantages of both approaches.
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Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - F Weber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Machens
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Brandenburg
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Führer-Sakel
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Díez JJ, Galofré JC, Oleaga A, Grande E, Mitjavila M, Moreno P. Characteristics of professionalism of specialists and advantages of multidisciplinary teams in thyroid cancer: results of a national opinion survey. ACTA ACUST UNITED AC 2019; 66:74-82. [PMID: 30612901 DOI: 10.1016/j.endinu.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The opinion of professionals about multidisciplinary teams (MDT) in thyroid cancer has not been studied in Spain. This study was intended to ascertain the opinion of specialists about the characteristics of the professionals and the advantages provided by these teams. METHODS A survey was designed to assess the opinion about the characteristics of professionalism and the advantages of MDT for patients, professionals, and the health care system. The survey was posted online from November 15, 2017 to February 15, 2018. RESULTS A total of 226 surveys were evaluated. The ability for teamwork was considered the most important characteristic to be met by professionals by 37.2% of respondents, while scientific competence was the most important indicator of professionalism for 37.6%. More than two thirds of specialists felt that MDTs improve the choice of treatments and diagnostic procedures, decrease clinical variability, facilitate implementation of clinical guidelines, improve ongoing training, and increase patient satisfaction and hospital prestige. The degree of agreement with the advantages of MDTs was significantly higher among specialists who had a MDT at their hospitals. CONCLUSIONS The overall opinion of professionals on the MDT model is highly favorable. Hospital managers and health care authorities should take these facts into account in order to encourage and support implementation of these teams.
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Affiliation(s)
- Juan J Díez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Juan Carlos Galofré
- Servicio de Endocrinología, Clínica Universidad de Navarra, Pamplona, España
| | - Amelia Oleaga
- Servicio de Endocrinología y Nutrición, Hospital Universitario Basurto, Bilbao, España
| | - Enrique Grande
- Servicio de Oncología Médica, MD Anderson Cancer Center, Madrid, España
| | - Mercedes Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Pablo Moreno
- Servicio de Cirugía General, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Twining CL, Lupo MA, Tuttle RM. Implementing Key Changes in the American Thyroid Association 2015 Thyroid Nodules/Differentiated Thyroid Cancer Guidelines Across Practice Types. Endocr Pract 2018; 24:833-840. [PMID: 30308136 DOI: 10.4158/ep-2018-0130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This article provides suggestions to help clinicians implement important changes in the 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Carcinoma ("ATA 2015") across diverse settings. METHODS Key ATA 2015 changes are summarized regarding: ( 1) thyroid nodule management; ( 2) lobectomy versus thyroidectomy for differentiated thyroid carcinoma (DTC); and ( 3) surveillance following primary treatment of DTC. Advice to facilitate implementation is based on clinical experience and selected literature. RESULTS Strategies are described to enhance acquisition of high-quality information that helps identify patients who may possibly avoid fine-needle aspiration (FNA) of thyroid nodules or total thyroidectomy for DTC, or undergo less intense postoperative surveillance. Sonographic imaging of nodules may improve if sonograms are obtained by clinicians ordering or performing FNA or trusted high-volume sonographers. Cytopathologic assessment and reporting can be improved by working with regional or national experts. Pre-operative evaluation by endocrinologists is important so that patients are referred to experienced, proficient surgeons and assisted with well-informed decision-making regarding surgical radicality. Endocrinologists and surgeons should ensure performance of pre-operative neck ultrasonography, voice/laryngeal evaluation, and contrast-enhanced cross-sectional imaging when appropriate. Findings should be disseminated to all healthcare team members, ideally through a comprehensive medical record accessible to the entire team. CONCLUSION Optimization of the sequence of specialist visits and assembly of interactive multidisciplinary teams coupled with intensified interdisciplinary and patient communication may enable clinicians to more effectively implement ATA 2015, which calls for more individualized, and often, less "invasive" management of thyroid nodules and DTC. ABBREVIATIONS ATA 2009 = 2009 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Carcinoma; ATA 2015 = 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Carcinoma; DTC = differentiated thyroid carcinoma; FNA = fine-needle aspiration; PET/CT = positron emission tomography/computed tomography.
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Moubayed SP, Machado R, Tuttle RM, Orloff LA, Randolph G, Hernandez-Prera JC, Griffin MJ, Urken ML. Enhanced interdisciplinary communication: development of an interactive thyroid nodule/cancer disease map. Laryngoscope 2018; 129:269-274. [PMID: 30194697 DOI: 10.1002/lary.27244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Deficits related to inadequate clinical communication can result in incorrect diagnoses, inappropriate surgery, incorrect disease stratification, pathologic reporting, and/or interpretation. There are currently no validated or defined solutions to disease-specific communication with regard to thyroid care. METHODS We propose a solution that could ameliorate problems arising from inadequate disease-specific communications between physicians through the development of a thyroid disease-specific database, the Thyroid Care Collaborative. RESULTS To improve the quality of thyroid nodule and cancer care, we have developed an imaging module for enhanced reporting of ultrasound, cytologic, surgical, and pathologic details that are obtained during the workup and treatment of a patient. CONCLUSION The main advantages of this disease-specific, dynamic, three-dimensional, anatomic disease map are: 1) portability across institutions and disciplines, 2) disease specificity to thyroid nodule and cancer care, and 3) ability to trigger more detailed evaluation or reconciliation of any change in a patient's status regarding the nature or the extent of a patient's disease. The first and second advantages above have been identified as areas representing opportunities for quality improvement in health informatics research. Laryngoscope, 129:269-274, 2019.
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Affiliation(s)
- Sami P Moubayed
- Thyroid, Head and Neck Cancer (THANC) Foundation the Department of Surgery, Université de Montréal, Montreal, Quebec, CA.,Department of Otolaryngology-Head and Neck Surgery
| | - Rosalie Machado
- Thyroid, Head and Neck Cancer (THANC) Foundation the Department of Surgery, Université de Montréal, Montreal, Quebec, CA
| | - R Michael Tuttle
- Department of Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Gregory Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Juan C Hernandez-Prera
- Department of Pathology, Moffit Cancer Center, Icahn School of Medicine at Mount Sinai and Mount Sinai Beth Israel, Tampa, Florida, U.S.A
| | - Martha J Griffin
- Thyroid, Head and Neck Cancer (THANC) Foundation the Department of Surgery, Université de Montréal, Montreal, Quebec, CA
| | - Mark L Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation the Department of Surgery, Université de Montréal, Montreal, Quebec, CA.,Department of Otolaryngology-Head and Neck Surgery
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Less is More: The Impact of Multidisciplinary Thyroid Conference on the Treatment of Well-Differentiated Thyroid Carcinoma. World J Surg 2018; 42:343-349. [PMID: 29058064 DOI: 10.1007/s00268-017-4308-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND In 2006, a multidisciplinary thyroid conference (MDTC) was implemented to better plan management of thyroid cancer patients at our institution. This study assessed the clinical impact of a MDTC on radioactive iodine (RAI) treatment patterns. METHODS A prospective database (2003-2014) collected patient and tumor characteristics, RAI doses, and tumor recurrences. Patients treated with total thyroidectomy for differentiated thyroid carcinoma ≥1 cm were stratified based on American Thyroid Association (ATA) risk classification. RAI regimens were compared before initiation of MDTC (2003-2005, n = 88), after establishment of MDTC (2007-2009, n = 95), and after the release of 2009 ATA guidelines (2011-2014, n = 181). RAI doses were defined as low (≤75 mCi), intermediate (76-150 mCi), and high (>150 mCi). RESULTS There was a significant decrease in the number of patients who received high-dose RAI after implementation of MDTC compared to before initiation of MDTC in the intermediate and high-risk patient groups (p = 0.04 and p < 0.01) without an associated increase in tumor recurrence (11 vs. 7%, p = 0.74). On multivariable analysis, presentation of a patient at MDTC was a negative predictor for receiving high-dose RAI (p = 0.002). As might be expected, there was also a significant decrease in use of RAI after the 2009 ATA guidelines were issued compared to after implementation of MDTC (p < 0.01). CONCLUSION In conjunction with implementation of a thyroid malignancy multidisciplinary conference, we observed significantly decreased postoperative dosing of RAI without increased tumor recurrence. The 2009 ATA guidelines were associated with a further decrease in RAI administration. Treatment for patients with thyroid carcinoma is optimized by a multidisciplinary approach.
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Likhterov I, Osorio M, Moubayed SP, Hernandez-Prera JC, Rhodes R, Urken ML. The Ethical Implications of the Reclassification of Noninvasive Follicular Variant Papillary Thyroid Carcinoma. Thyroid 2016; 26:1167-72. [PMID: 27480127 DOI: 10.1089/thy.2016.0212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several studies have highlighted the lack of consensus in the diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC). An international multidisciplinary panel to address the controversy was assembled at the annual meeting of the Endocrine Pathology Society in March of 2015, leading to the recent publication reclassifying encapsulated (or noninvasive) FVPTC (EFVPTC) as a benign neoplasm. Does this change in histologic taxonomy warrant a change in clinical practice, and how should it affect those who have been given this diagnosis in the past? We consider the financial and psychological impact of this reclassification and discuss the ethical, legal, and practical issues involved with sharing this information with the patients who are affected. SUMMARY The total direct and indirect cost of thyroid cancer surveillance in patients is significant. High levels of clinically relevant distress affect up to 43% of patients with papillary thyroid carcinoma, as estimated by the Distress Thermometer developed by the National Comprehensive Cancer Network for detecting distress in cancer patients. Although there are currently no legal opinions that establish a precedent for recontacting patients whose clinical status is altered by a change in nomenclature, the prudent course would be to attend to the requirements of medical ethics. CONCLUSION Informing patients with a previous diagnosis of EFVPTC that the disease has been reclassified as benign is expected to have a dramatic effect on their surveillance needs and to alleviate the psychological impact of living with a diagnosis of cancer. It is important to re-evaluate the pathologic slides of those patients at risk to ensure that the invasive nature of the tumor is comprehensively evaluated before notifying a patient of a change in diagnosis. The availability of the entire tumor for evaluation of the capsule may prove to be a challenge for a portion of the population at risk. We believe that it is the clinician's professional duty to make a sincere and reasonable effort to convey the information to the affected patients. We also believe that the cost savings with respect to the need for additional surgery, radioactive iodine, and rigorous surveillance associated with a misinterpretation of the biology of the diagnosis of EFVPTC in less experienced hands will likely more than offset the cost incurred in histologic review and patient notification.
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Affiliation(s)
- Ilya Likhterov
- 1 Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | - Marcela Osorio
- 2 Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Sami P Moubayed
- 1 Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | | | - Rosamond Rhodes
- 4 Icahn School of Medicine at Mount Sinai New York , New York
| | - Mark L Urken
- 1 Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
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Likhterov I, Tuttle RM, Haser GC, Su HK, Bergman D, Alon EE, Bernet V, Brett E, Cobin R, Dewey EH, Doherty G, Dos Reis LL, Klopper J, Lee SL, Lupo MA, Machac J, Mechanick JI, Milas M, Orloff L, Randolph G, Ross DS, Rowe ME, Smallridge R, Terris D, Tufano RP, Urken ML. Improving the adoption of thyroid cancer clinical practice guidelines. Laryngoscope 2016; 126:2640-2645. [PMID: 27074952 DOI: 10.1002/lary.25986] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present an overview of the barriers to the implementation of clinical practice guidelines (CPGs) in thyroid cancer management and to introduce a computer-based clinical support system. DATA SOURCES PubMed. REVIEW METHODS A review of studies on adherence to CPGs was conducted. RESULTS Awareness and adoption of CPGs is low in thyroid cancer management. Barriers to implementation include unfamiliarity with the CPGs and financial concerns. Effective interventions to improve adherence are possible, especially when they are readily accessible at the point of care delivery. Computerized clinical support systems show particular promise. The authors introduce the clinical decision making modules (CDMMs) of the Thyroid Cancer Care Collaborative, a thyroid cancer-specific electronic health record. These computer-based modules can assist clinicians with implementation of these recommendations in clinical practice. CONCLUSION Computer-based support systems can help clinicians understand and adopt the thyroid cancer CPGs. By integrating patient characteristics and guidelines at the point of care delivery, the CDMMs can improve adherence to the guidelines and help clinicians provide high-quality, evidence-based, and individualized patient care in the management of differentiated thyroid cancer. Laryngoscope, 126:2640-2645, 2016.
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Affiliation(s)
- Ilya Likhterov
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| | | | - Grace C Haser
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York.
| | - Henry K Su
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Donald Bergman
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eran E Alon
- Department of Otolaryngology - Head and Neck Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Victor Bernet
- Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida, U.S.A
| | - Elise Brett
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rhoda Cobin
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eliza H Dewey
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Gerard Doherty
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Laura L Dos Reis
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Joshua Klopper
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Stephanie L Lee
- Section of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Mark A Lupo
- Thyroid & Endocrine Center of Florida, Florida State University College of Medicine, Sarasota, Florida, U.S.A
| | - Josef Machac
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Diseases, and the Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mira Milas
- Section of Endocrine Surgery, Department of Surgery, Banner-University Medical Center Phoenix, Phoenix, Arizona, U.S.A
| | - Lisa Orloff
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Gregory Randolph
- Department of Otolaryngology and the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Douglas S Ross
- Department of Otolaryngology and the Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Meghan E Rowe
- Department of Otolaryngology - Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Robert Smallridge
- Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida, U.S.A
| | - David Terris
- Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Mark L Urken
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
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Díez JJ, Galofré JC, Oleaga A, Grande E, Mitjavila M, Moreno P. [Consensus statement for accreditation of multidisciplinary thyroid cancer units]. ACTA ACUST UNITED AC 2015; 63:e1-15. [PMID: 26456892 DOI: 10.1016/j.endonu.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/24/2022]
Abstract
Thyroid cancer is the leading endocrine system tumor. Great advances have recently been made in understanding of the origin of these tumors and the molecular biology that makes them grow and proliferate, which have been associated to improvements in diagnostic procedures and increased availability of effective local and systemic treatments. All of the above makes thyroid cancer a paradigm of how different specialties should work together to achieve the greatest benefit for the patients. Coordination of all the procedures and patient flows should continue throughout diagnosis, treatment, and follow-up, and is essential for further optimization of resources and time. This manuscript was prepared at the request of the Working Group on Thyroid Cancer of the Spanish Society of Endocrinology and Nutrition, and is aimed to provide a consensus document on the definition, composition, requirements, structure, and operation of a multidisciplinary team for the comprehensive care of patients with thyroid cancer. For this purpose, we have included contributions by several professionals from different specialties with experience in thyroid cancer treatment at centers where multidisciplinary teams have been working for years, with the aim of developing a practical consensus applicable in clinical practice.
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Affiliation(s)
- Juan José Díez
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, España.
| | - Juan Carlos Galofré
- Departamento de Endocrinología, Clínica Universidad de Navarra, Pamplona, España
| | - Amelia Oleaga
- Servicio de Endocrinología, Hospital Universitario Basurto, Bilbao, España
| | - Enrique Grande
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Mercedes Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Pablo Moreno
- Servicio de Cirugía General y Digestiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Mehra S, Tuttle RM, Milas M, Orloff L, Bergman D, Bernet V, Brett E, Cobin R, Doherty G, Judson BL, Klopper J, Lee S, Lupo M, Machac J, Mechanick JI, Randolph G, Ross DS, Smallridge R, Terris D, Tufano R, Alon E, Clain J, DosReis L, Scherl S, Urken ML. Database and registry research in thyroid cancer: striving for a new and improved national thyroid cancer database. Thyroid 2015; 25:157-68. [PMID: 25517683 DOI: 10.1089/thy.2014.0270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health registries have become extremely powerful tools for cancer research. Unfortunately, certain details and the ability to adapt to new information are necessarily limited in current registries, and they cannot address many controversial issues in cancer management. This is of particular concern in differentiated thyroid cancer, which is rapidly increasing in incidence and has many unknowns related to optimal treatment and surveillance recommendations. SUMMARY In this study, we review different types of health registries used in cancer research in the United States, with a focus on their advantages and disadvantages as related to the study of thyroid cancer. This analysis includes population-based cancer registries, health systems-based cancer registries, and patient-based disease registries. It is important that clinicians understand the way data are collected in, as well as the composition of, these different registries in order to more critically interpret the clinical research that is conducted using that data. In an attempt to address shortcoming of current databases for thyroid cancer, we present the potential of an innovative web-based disease management tool for thyroid cancer called the Thyroid Cancer Care Collaborative (TCCC) to become a patient-based registry that can be used to evaluate and improve the quality of care delivered to patients with thyroid cancer as well as to answer questions that we have not been able to address with current databases and registries. CONCLUSION A cancer registry that follows a specific patient, is integrated into physician workflow, and collects data across different treatment sites and different payers does not exist in the current fragmented system of healthcare in the United States. The TCCC offers physicians who treat thyroid cancer numerous time-saving and quality improvement services, and could significantly improve patient care. With rapid adoption across the nation, the TCCC could become a new paradigm for database research in thyroid cancer to improve our understanding of thyroid cancer management.
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Affiliation(s)
- Saral Mehra
- 1 Department of Surgery (Otolaryngology), Yale School of Medicine , New Haven, Connecticut
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