Follow Up of Well-Differentiated Thyroid Cancers in CMDHB
Authors List
Nurdjaja, V., Middlemore Hospital, Auckland, New Zealand
Mclaren, H., Middlemore Hospital, Auckland, New Zealand
Shetty S., Middlemore Hospital, Auckland, New Zealand
Biggar, M., Middlemore Hospital, Auckland, New Zealand
Introduction: Patients with well-differentiated thyroid cancer who undergo total thyroidectomy often have excellent long-term survival. Published guidelines recommend long term patient follow up to detect recurrence early, but clinician adherence to guidelines is unclear. It is also important to identify impact of ethnicity on adherence, and any disparities which may need to be addressed.
Aim: To discover adherence rates to recommended American Thyroid Association follow up guidelines in secondary and primary care settings in Counties Manukau District Health Board (CMDHB) and identify ethnic disparities.
Methods: Data collection was conducted of all CMDHB patients who underwent total or completion thyroidectomy from 2010-2014. Demographics, histology, and risk stratification profiles were recorded. Follow up in secondary care was documented by time to first and final specialist follow up, cervical ultrasound (USS), thyroid stimulating hormone (TSH) and thyroglobulin (Tg) check within the first-year post op. Ongoing community follow up was evaluated by Tg and TSH monitoring. Fisher exact test and Kruskal Wallis test were utilized for data analysis.
Results: Of 84 patients, there were 22 Asian, 19 European, 14 Maori, 23 Pacific, 6 other/not stated. 67.8% received Tg, 23.8% cervical USS, 76.2% TSH within one year post op. There were significantly more patients who had long term TSH follow up in the community 83.1% (95% CI 74.8%, 91.5%) compared with Tg 36.6% (95% CI 26.2%, 47.4%). No significant ethnic disparities were found.
Conclusion: Rates of adherence to Tg and TSH are adequate in specialist care, but significantly lower for cervical USS. In contrast, there is a significant lack of ongoing Tg surveillance in the community compared with TSH follow up. This implies that we need to raise awareness among primary care clinicians regarding the purpose of Tg and importance of ongoing monitoring for cancer surveillance. Ethnicity had no significant impact on follow up outcomes.
Nurdjaja, V., Middlemore Hospital, Auckland, New Zealand
Mclaren, H., Middlemore Hospital, Auckland, New Zealand
Shetty S., Middlemore Hospital, Auckland, New Zealand
Biggar, M., Middlemore Hospital, Auckland, New Zealand
Introduction: Patients with well-differentiated thyroid cancer who undergo total thyroidectomy often have excellent long-term survival. Published guidelines recommend long term patient follow up to detect recurrence early, but clinician adherence to guidelines is unclear. It is also important to identify impact of ethnicity on adherence, and any disparities which may need to be addressed.
Aim: To discover adherence rates to recommended American Thyroid Association follow up guidelines in secondary and primary care settings in Counties Manukau District Health Board (CMDHB) and identify ethnic disparities.
Methods: Data collection was conducted of all CMDHB patients who underwent total or completion thyroidectomy from 2010-2014. Demographics, histology, and risk stratification profiles were recorded. Follow up in secondary care was documented by time to first and final specialist follow up, cervical ultrasound (USS), thyroid stimulating hormone (TSH) and thyroglobulin (Tg) check within the first-year post op. Ongoing community follow up was evaluated by Tg and TSH monitoring. Fisher exact test and Kruskal Wallis test were utilized for data analysis.
Results: Of 84 patients, there were 22 Asian, 19 European, 14 Maori, 23 Pacific, 6 other/not stated. 67.8% received Tg, 23.8% cervical USS, 76.2% TSH within one year post op. There were significantly more patients who had long term TSH follow up in the community 83.1% (95% CI 74.8%, 91.5%) compared with Tg 36.6% (95% CI 26.2%, 47.4%). No significant ethnic disparities were found.
Conclusion: Rates of adherence to Tg and TSH are adequate in specialist care, but significantly lower for cervical USS. In contrast, there is a significant lack of ongoing Tg surveillance in the community compared with TSH follow up. This implies that we need to raise awareness among primary care clinicians regarding the purpose of Tg and importance of ongoing monitoring for cancer surveillance. Ethnicity had no significant impact on follow up outcomes.
