Treatment patterns of aging Americans with differentiated thyroid cancer

Abstract

BACKGROUND:The incidence of differentiated thyroid cancer (DTC) increases with age. Total thyroidectomy, often followed by radioactive iodine (RAI), is recommended for patients who have tumors that measure !1 cm in greatest dimension. In the current study, the authors assessed the use of thyroidectomy and RAI among elderly patients with DTC and the effects on survival. METHODS: Adults aged !45 years with DTC !1 cm in the Surveillance, Epidemiology, and End Results database from 1988 to 2003 were included. Bivariate and multivariate analyses were used to measure associations between demographic, clinical, and pathologic characteristics and the likelihood of receiving treatment according to current practice guidelines. RESULTS: Of 8899 patients who were identified, 26% were ages 65 years to 79 years, and 5% were aged !80 years. Compared with younger patients, patients aged ! 65 years were more likely to have larger tumors, stage IV disease, extrathyroid extension, and nonpapillary histology. Elderly patients were less likely to undergo total thyroidectomy (74% vs 80%; P < .001) or to receive RAI (47% vs 54%; P < .001). These trends were most pronounced among those aged !80 years. Among the patients who did not undergo surgery, elderly patients did not report higher rates of contraindications to surgery. In multivariate analysis, the groups ages 65 years to 79 years and aged !80 years were associated with lower rates of total thyroidectomy (odds ratio, 0.77 and 0.43, respectively; P < .001) and RAI (odds ratio, 0.85 [P < .01] and 0.39 [P < .001], respectively). Among elderly patients, predictors of worse survival included no surgery (hazard ratio, 5.51; P < .001) and no RAI (hazard ratio, 1.36; P < .001). CONCLUSIONS: Elderly patients with DTC received less aggressive surgical and RAI treatment than younger patients despite having more advanced disease and the improved survival associated with these treatments among elderly patients. Long-term outcomes should be measured to determine the impact of this apparent discrepancy in care. Cancer 2010;116:20-30.

Comparative clinicopathological and outcome analysis of differentiated thyroid cancer in Saudi patients aged below 60 years and above 60 years

“…In the present study, no significant difference was observed in primary tumor volumes between the two age groups, which is consistent with the reported literature 14. In contrast to patients aged below 60 years, the pathological positive neck nodes were significantly higher in patients aged above 60 years, owing to the presence of lymphovascular space invasion, multifocality, and aggressive histopathological variants in elderly patients, which supports the routine use of lateral neck dissection in this age group 15,16…”

Referral of Older Thyroid Cancer Patients to A High-Volume Surgeon: Results of A Multidisciplinary Physician Survey

“…(22) However, it was previously demonstrated that elderly patients with differentiated thyroid cancers receive less aggressive surgical and radioactive iodine treatment than younger patients, despite having more advanced disease and improved survival associated with treatment. (17) Successful surgery for thyroid cancer has been shown to not only increase the survival rate but also improve the quality of life of older patients. (23) It is generally perceived that the elderly may have increased operative risks because of the presence of increasing number of comorbidities, thus leading to a more conservative or non-operative approach to be adopted in these patients with thyroid cancer.…”

“…(9–16) However, current data show that older patients with thyroid cancer are less likely to receive guideline concordant care. (17) Additionally, older age and Medicare insurance were found to be independently associated with less aggressive management of patients with high-risk thyroid cancer. (18)…”

Optimal Differentiated Thyroid Cancer Management in the Elderly

“…There is also evidence that older patients are less likely to receive total thyroidectomy [24], be referred for specialist surgical care involving travel of a large distance [25], or receive treatment with radioiodine [24,26]. It is unclear whether these differences reflect difficulty of access to treatment for older patients, a bias in clinicians against aggressive treatment with increasing age, or use of individualised risk-benefit decision making leading to less aggressive therapy.…”