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The role of clinicians in determining radioactive iodine use for low‐risk thyroid cancer
Author(s) -
Haymart Megan R.,
Banerjee Mousumi,
Yang Di,
Stewart Andrew K.,
Koenig Ronald J.,
Griggs Jennifer J.
Publication year - 2012
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.27721
Subject(s) - medicine , thyroid cancer , specialty , thyroidectomy , thyroid , cancer , family medicine , emergency medicine
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.