Is conservative management of the indeterminate thyroid nodule [Thy3f or Bethesda category IV] safe?

PURPOSE

The histological diagnosis after diagnostic thyroidectomy for indeterminate thyroid nodules is often non-malignant and some cancers detected are considered 'indolent'. The safety and effectiveness of conservative management in these patients are unclear. The aim of this study was to determine the safety of conservative management of indeterminate thyroid nodules and to explore association between clinical features and pathology in patients undergoing surgery.

METHODS

This is a retrospective cohort study of patients presenting to a single centre over a 4-year period (2013-2016) with thyroid nodules that were considered indeterminate (thy3f in the UK RCPath classification) on cytology. Demographic data, ultrasound features, follow-up details (in those undergoing conservative management) and histology details (in those undergoing surgery) were collected.

RESULTS

Of 164 patients that had Thy3f cytology, 34 were initially managed conservatively; however, 4 of these eventually had surgery (due to patient preference). No patient on conservative management had significant disease progression on ultrasound at a median (interquartile range) of 27 (16-40) months. Of the 134 patients that underwent surgery, 26 had thyroid malignancy. The BTA 'U' classification, gender and age (> 55) were not associated with malignancy in these nodules, but larger nodules (> 40 mm) were more likely to be malignant (p = 0.042).

CONCLUSIONS

Conservative management of indeterminate (Thy3f or Bethesda stage IV) thyroid nodules is safe in the short term and may be indicated in selected cases after appropriate discussion of risks and benefits of surgery.

A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer

BACKGROUND

Cancer can affect many dimensions of a patient's life, and in turn, it should be targeted using a multimodal approach. We tested the extent to which an interdisciplinary nutrition-rehabilitation program can improve the well-being of patients with advanced cancer.

METHODS

Between January 10, 2007, and September 29, 2010, 188 patients with advanced cancer enrolled in the 10-12-week program. Body weight, physical function, symptom severity, fatigue dimensions, distress level, coping ability, and overall quality of life were assessed at the start and end of the program.

RESULTS

Of the enrolled patients, 70% completed the program. Patients experienced strong improvements in the physical and activity dimensions of fatigue (effect sizes: 0.8-1.1). They also experienced moderate reductions in the severity of weakness, depression, nervousness, shortness of breath, and distress (effect sizes: 0.5-0.7), and moderate improvements in Six Minute Walk Test distance, maximal gait speed, coping ability, and quality of life (effect sizes: 0.5-0.7) Furthermore, 77% of patients either maintained or increased their body weight.

CONCLUSIONS

Interdisciplinary nutrition-rehabilitation can be advantageous for patients with advanced cancer and should be considered an integrated part of standard palliative care.

The McGill Cancer Nutrition and Rehabilitation Program

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Background: Cancer rehabilitation is a process that assists the individual with cancer to obtain optimal physical, social, psychological, and vocational functioning within the limits created by the disease and treatment. The McGill Cancer Nutrition and Rehabilitation (CNR) program developed as a result of the ever-increasing demand to address the individual cancer patients and their needs, as well as on achieving optimal tumour-related outcomes. Methods: To assess the effect of an interdisciplinary 8-week rehabilitation program on the functional outcomes of patients with advanced cancer. Sixty-five patients were assessed prior to and following an 8-week interdisciplinary cancer rehabilitation program consisting of medical, nursing, physiotherapy and nutritional interventions. All patients were evaluated with the Edmonton Symptom assessment Score (ESAS), Distress thermometer (DT), Patient Generated Subjective Global Assessment (PG-SGA), Simmonds Functional Assessment Tool and the 6-Minute Walk Test (6MWT). A paired t-test comparing patient’ pre and posttest scores was used. Results: Thirty three male and 32 female participants were enrolled. Their median age was 57 years (25 to 80). Their cancer diagnoses were: gastro-esophageal (20%), hepatobiliary (19%), breast (17%), hematological (12%), lung, ENT and sarcoma (9% each), colorectal (3%) and CNS lymphoma (2%) There was a significant improvement after an 8-week cancer rehabilitation program in strength (p=. 02), appetite (p< 0.001), nausea (p< =0.02), nervousness (p< 0.001) sleepiness (p=0.01), shortness of breath (p=0.02), depression (p< 0.001), DT (p< 0.001), total PG-SGA score (p< 0.001) and 6MWT (p=0.001). Conclusions: Preliminary findings suggest that participation in a cancer rehabilitation program ameliorates symptoms and global distress resulting in an increase in physical activities. We can conclude that participation in the Cancer Rehabilitation Program is beneficial.

No significant financial relationships to disclose.

Family response to difficult hospitalizations: the phenomenon of 'working through'

This paper describes the process and outcomes of a project to learn about qualitative research methods. A small study of family participation in decision-making was conducted with 7 family members who were interviewed after an inter-unit patient transfer. The data analysis used strategies derived from grounded theory, family life-cycle framework and storytelling. The interviews indicated respondents' concerns about the patient, their efforts to balance their lives during a time of disarray and their sorting through crises in their lives ('working through'). 'Working through' discourse has identifiable features, including: linking the past, present and future; refrains; rhetorical questions; and self-talk. Clinicians should encourage the 'working through' process by family during the hospitalization of a family member.