Disparities in the Care of Differentiated Thyroid Cancer in the United States: Exploring the National Cancer Database

Jaap, Kathryn; Campbell, Rebekah A.; Dove, James T.; Fluck, Marcus; Hunsinger, Marie; Wild, Jeffrey; Arora, Tania K.; Shabahang, Mohsen; Blansfield, Joseph

doi:10.1177/000313481708300731

Cited by 9 publications

(8 citation statements)

References 32 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given that previous studies highlighted the racial and ethnic disparities in presentation, treatment, and prognosis of patients with DTC, [7][8][9][10][12][13][14] we examined whether adoption of the AJCC8 staging system affected the prognosis of self-reported racial and ethnic groups equally. Our study is the first to demonstrate that downstaging did affect self-reported race and ethnic groups differently.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies reported that blacks had a higher incidence of follicular variant of PTC (FVPTC), a higher potential of developing distant metastasis from FVPTC, were less likely to receive appropriate thyroid surgery compared with whites, and were also less likely to have received radioactive iodine. [6][7][8][9][10][11] Moreover, in a study of adolescents and young adults with DTC in California, thyroid cancer-specific mortality was decreased in blacks and Hispanics. 10 Taking into account the significant disparities that exist among self-reported racial and ethnic groups in DTC, the hypothesis of our study was that the changes in staging (i.e., down-staging) introduced by the AJCC8 impacted the prognosis of racial and ethnic groups differently.…”

Section: Introductionmentioning

confidence: 99%

“…A study from the Surveillance, Epidemiology, and End Results Program (SEER) found that blacks had a decreased thyroid cancer‐specific survival, were more likely to have larger tumors, and more likely to have FTC. Other studies reported that blacks had a higher incidence of follicular variant of PTC (FVPTC), a higher potential of developing distant metastasis from FVPTC, were less likely to receive appropriate thyroid surgery compared with whites, and were also less likely to have received radioactive iodine 6–11 . Moreover, in a study of adolescents and young adults with DTC in California, thyroid cancer‐specific mortality was decreased in blacks and Hispanics 10 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes

et al. 2022

View full text Add to dashboard Cite

Background: The impact of AJCC8 among self-reported racial/ethnic groups on differentiated thyroid cancer (DTC) outcomes is unknown.Methods: Multivariate-regression evaluated the association between AJCC7 to AJCC8 stage change and race/ethnicity in patients with DTC in the NCDB. Cox-proportional-regression evaluated whether AJCC7 to AJCC8 stage change affects overall survival (OS) differently based on reported race/ ethnicity.Results: After adjusting for confounders, Hispanics and Asian-Pacific-Islanders (APIs) were 27% and 12% less likely to be down-staged compared to white-non-Hispanics (WNHs) (p < 0.001); black-non-Hispanics (BNHs) had no significant down-staging difference. Down-staged patients had an increased risk of death compared to patients with unchanged staging, regardless of race/ ethnicity. However, based on two-way interaction, the magnitude of this negative change on survival from down-staging was only different between WNHs (HR = 2.64) and BNHs (HR = 1.77), (p = 0.04). Conclusions: Outcome disparities persist among self-reported racial/ethnic groups with AJCC8. Down-staged patients across all racial/ethnic groups had decreased survival compared to those with unchanged stage, with the least impact in BNHs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Only the annual household income had a significant effect on VAS change 1 year postoperatively compared with pre‐operative status. In the US, a delayed diagnosis and therapy of thyroid cancer have been shown in black and uninsured patients as well as in families with low income . Although the German cannot be compared with the American health system, it seems that the household income affects health‐related QoL in thyroid disease transnationally.…”

Section: Discussionmentioning

confidence: 99%

Quality of life is not affected by thyroid surgery in nontoxic benign goitre in long‐term surveillance—A prospective observational study

Tabriz

Uslar

Tabriz

et al. 2020

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

Objective: Quality of life (QoL) has so far seldom been taken into account by default in decision-making for surgical indication in thyroid surgery. Therefore, we compared pre-and postoperative QoL of patients using the EuroQoL-5D (EQ-5D) questionnaire. The influence of certain socio-economic factors on QoL as a second end-point was considered.Design: Prospective cohort study.Patients: About 153 patients with euthyroid symptomatic benign goitre after hemiand total thyroidectomy (follow-up 83.6%) have been included. Measurements:The EQ-5D questionnaire was used prior to and 1 year after surgery.In addition, a questionnaire for assessment of socio-economic status was collected. Results: For n = 90 (n = 67 female, n = 23 male), total thyroidectomy (TT) and, for n = 63 (n = 45 female, n = 18 male), hemithyroidectomy (HT) were performed. None permanent dysfunction of the vocal cord was recorded. Transient symptomatic hypocalcaemia was detected in 9% of the thyroidectomy group (8/90 patients). At follow-up, 86% of patients showed either no change or improved QoL. About 14% of patients complained of deteriorated QoL, regardless of the extent of surgery. Socioeconomic factors did not influence postoperative QoL. Conclusions:Results indicate that in pre-operative consultation of patients with benign goitre, the improvement of QoL should be taken into account for decision-making in cases of ambiguous surgical indication. Contrary to current discussions that too much thyroid surgery is performed in Germany, we can recommend presenting surgery as an equivalent option to watchful waiting as QoL is at least preserved or improved. The extension of the resection should, however, be decided individually. K E Y W O R D SEQ-5D, health-related quality of life, hemithyroidectomy, patient-reported outcome, PRO, QoL, total thyroidectomy

show abstract

“…Multiple studies have observed differences in patterns of care for a variety of cancer sites (e.g. breast, thyroid) at different types of cancer centers, which have evolved over time [ 10 , 11 ]. In this study we obtained available data from the NCDB on variables included in the management of SCCA in the United States to compare patient demographics and care delivery between ACPs and CCPs.…”

Section: Introductionmentioning

confidence: 99%

Patterns of care for anal cancer in the United States - a comparison between academic and community cancer centers

Pricolo¹,

Bonvini²,

Abelli³

2018

BMC Cancer

View full text Add to dashboard Cite

BackgroundManagement of squamous cell carcinoma of the anus (SCCA) is becoming more relevant, as its incidence increases. The purpose of this study was to investigate possible differences in patient population and care delivery for SCCA between academic and community cancer programs in the United States.MethodsA review of available data from the American College of Surgeons Committee on Cancer National Cancer DataBase focused on gender, age, race, type of health insurance, comorbidity score, distance traveled for care, stage at diagnosis, and therapy utilization (surgery, chemotherapy, and radiation therapy) as first course of treatment (FCT). The analysis included 38,766 patients treated for SCCA. Of them, 14,422 patients received treatment at Academic Cancer Programs (ACPs), while 24,344 were treated at Community Cancer Programs (CCPs) between the years 2003 and 2013.ResultsOver the 11-year study period, ACPs had significantly more male patients, of younger age, a greater non-white race population, with more Medicaid or no insurance coverage, who traveled farther for cancer center care (p < 0.001). There was no difference between ACPs and CCPs with respect to Charlson co-morbidity score and stage of SCCA at diagnosis. For stage 0 patients, use of chemotherapy was 8% for ACPs, 9% for CCPs, and use of radiotherapy was 10% for ACPs and 14% for CCPs. The incidence of stage unknown was identical at both ACPs and CCPs (11.5%). CCPs had a greater overall utilization of radiation therapy as FCT for stage 0, I, II and IV patients (p < 0.001).ConclusionsOur study indicates that gender, demographic and socio-economic differences exist in the patient population with SCCA accessing different cancer programs in the US. The high incidence of stage unknown patients reflects ongoing challenges in the pre-treatment phase. A significant percentage of stage 0 patients received systemic chemotherapy and/or radiotherapy, rather than surgery alone. Despite comparable stage at diagnosis and comorbidity scores between ACPs and CCPs, there appear to be variations in treatment choices, especially with the use of radiotherapy, with associated cost and toxicity risks. Further analysis and monitoring of SCCA management in the US may lead to improved compliance with NCCN guidelines.

show abstract

Disparities in the Care of Differentiated Thyroid Cancer in the United States: Exploring the National Cancer Database

Cited by 9 publications

References 32 publications

Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes

Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes

Quality of life is not affected by thyroid surgery in nontoxic benign goitre in long‐term surveillance—A prospective observational study

Patterns of care for anal cancer in the United States - a comparison between academic and community cancer centers

Contact Info

Product

Resources

About