BACKGROUND
Thyroid cancer is common. While most patients with thyroid cancer are adults, thyroid cancer also occurs in children. Overall, the prognosis is very good due, in large part, to effective treatments. However there are some factors that may contribute to worse outcomes. Some studies have previously shown that socioeconomic and racial inequalities can affect thyroid cancer care. Indeed, poor socioeconomic factors have been shown to contribute to poor thyroid cancer outcomes in adults. In particular, adults of certain races and with poor socioeconomic have been shown to correlate with more advanced stages of thyroid cancer at diagnosis and poorer outcomes with thyroid cancer treatments. More studies need to be done with the pediatric population.

This study was done to analyze the effect of race and socioeconomic status on the outcomes of thyroid cancer in the pediatric population.

THE FULL ARTICLE TITLE
Zhao HH and Wilhelm SM Pediatric thyroid cancer: socioeconomic disparities and their impact on access to care. Surgery 2023;18:S0039-6060(23)00600-1; doi: 10.1016/j.surg.2023.08.036. PMID: 3783694.

SUMMARY OF THE STUDY
From the National Cancer database, pediatric patients below the age of 18 with a diagnosis of thyroid cancer were categorized into races of White, Black, and Hispanic. Patients’ socioeconomic factors such as insurance coverage and incomes were estimated based on their ZIP code entered into the American Community survey data.

The percentage of patients traveling more than 300 miles to receive their care increased from 7.2% in 2004-2008 to 14.1% in 2015-2019. Patients who waited 30-60 days for their initial thyroidectomy increased from 25% in 2001-2008 to 33.8% in 2016-2019. White patients travelled further for their care than Black or Hispanic patients. Lower income families and Medicaid patients were likely to travel further for their care than higher income families and patients with private insurance. Black and Hispanic patients were more likely to wait longer than 30 days for their initial thyroidectomies than White patients.

Black patients had poorer overall survival rates at 5 and 10 years as well as higher mortality rates compared to Hispanic and White patients. Hispanic patients tended to have more lymph node involvement with their thyroid cancer than White or Black patients. Medicaid patients had worse 10-year survivals for both differentiated and advanced thyroid cancer than patients with private insurance.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that income, insurance type, race, and ethnicity impact access to care and overall survival in pediatric patients with thyroid cancer. The underlying etiology in prolonged treatment wait times, need for travel to receive care, and worse outcome are unclear and warrant further investigation. These data indicate that patients should be encouraged to seek all available resources to optimize their medical care and reduce the gap in access to care. Providers should be flexible in offering appointments for patients who live a long distance from their medical facility.

—Pinar Smith, MD

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