Impact of age and comorbidity on thyroid cancer decision making
Impact of age and comorbidity on thyroid cancer decision making
Academic Year:
2014 - 2015 (June 1, 2014 through May 31, 2015)
Funding Requested:
$2,000.00
Project Dates:
-
Applicant(s):
Overview of the Project:
The incidence of thyroid cancer is rising and its aggressiveness increases with age. There is a recognized association between older age and worse outcomes. Surgical intervention remains the standard of care, in accordance with recent management guidelines. However, although age is not a contraindication to thyroid surgery, recent studies found that older patients with thyroid cancer are less likely to receive guideline concordant care, despite proven benefits. In addition, post-operative thyroid stimulating hormone (TSH) suppressive therapy is now considered standard of care for high-risk patients with differentiated thyroid cancer and results in improved clinical outcomes. Nevertheless, due to its adverse effects especially in older adults, the degree of TSH suppressive therapy may need to be adjusted accordingly in this population. In summary, although surgery and post-operative TSH suppressive therapy are considered standard of care for patients with differentiated thyroid cancer, the factors involved in thyroid cancer management decision-making in older adults remain unclear. Our project aims to determine whether patients with thyroid cancer aged ≥65 years receive optimal surgical treatment, including referral to experienced high volume surgeons, through the use of provider surveys. We expect to find unique barriers in the referral of patients ≥65 years versus younger adults. We will also determine the providers' role in post-operative thyroid hormone replacement in older adults with thyroid cancer. We expect to find that providers will not factor age, comorbidities, functional status, and risks for complications in their treatment algorithm regarding post-operative TSH suppressive therapy in older thyroid cancer patients.