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The role of clinicians in determining radioactive iodine use for low‐risk thyroid cancer
Authors
Alderman
Bilimoria
+27 more
Brown
Chen
Clark
Davies
Dillman
Fowler
Friese
Goodman
Gross
Hay
Hay
Haymart
Ito
Iyer
Jagsi
Jonklaas
Katz
Laycock
Mazzaferri
Nallamothu
Pace-Asciak
Podnos
Raval
Sawka
Shahinian
Solans
Wennberg
Publication date
15 January 2013
Publisher
'Wiley'
Doi
Cite
View
on
PubMed
Abstract
BACKGROUND: There is controversy regarding the optimal management of thyroid cancer. The proportion of patients with low‐risk thyroid cancer who received radioactive iodine (RAI) treatment increased over the last 20 years, and little is known about the role played by clinicians in hospital‐level RAI use for low‐risk disease. METHODS: Thyroid surgeons affiliated with 368 hospitals that had Commission on Cancer‐accredited cancer programs were surveyed. Survey data were linked to data reported to the National Cancer Database. A multivariable analysis was used to assess the relation between clinician decision makers and hospital‐level RAI use after total thyroidectomy in patients with stage I, well differentiated thyroid cancer. RESULTS: The survey response rate was 70% (560 of 804 surgeons). The surgeon was identified as the primary decision maker by 16% of the surgeons; the endocrinologist was identified as the primary decision maker by 69%, and a nuclear medicine, radiologist, or other physician was identified as the primary decision maker by 15%. In a multivariable analysis controlling for hospital case volume and hospital type, when the primary decision maker was in a specialty other than endocrinology or surgery, there was greater use of RAI at the hospital ( P < .001). A greater number of providers at the hospital where RAI was administered and having access to a tumor board also were associated with increased use of RAI ( P < .001 and P = .006, respectively). CONCLUSIONS: The specialty of the primary decision maker, the number of providers administering RAI, and having access to a tumor board were associated significantly with the use of RAI for stage I thyroid cancer. The findings have implications for addressing nonclinical variation between hospitals, with a marked heterogeneity in decision making suggesting that standardization of care will be challenging. Cancer 2013. © 2012 American Cancer Society. There is heterogeneity in clinician decision making for the management of patients with thyroid cancer. The specialty of the primary decision maker, the number of providers administering radioactive iodine, and access to a tumor board are associated significantly with the use of radioactive iodine for stage I thyroid cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96331/1/27721_ftp.pd
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info:doi/10.1002%2Fcncr.27721
Last time updated on 03/01/2020
Deep Blue at the University of Michigan
See this paper in CORE
Go to the repository landing page
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oai:deepblue.lib.umich.edu:202...
Last time updated on 05/03/2014