BACKGROUND
Thyroid cancer is common and there are effective treatments. As such, the risk of death form thyroid cancer is very low. The initial treatment is usually surgery to remove the cancer. This is best done by experienced surgeons. Depending on the results of the surgery, patients may be treated with radioactive iodine followed by levothyroxine therapy or levothyroxine therapy alone. Follow up of thyroid cancer includes serial neck ultrasounds and blood tests, watching for recurrence of the cancer. This is usually done under the care of specialists (Endocrinologists and/or Oncologists).

Differences in the care of patients with thyroid cancer can affect how things turn out. Patients operated on by surgeons with less experience may stay longer in the hospital due to complications and need repeat operations of all of the cancer is not removed initially. Those that are not followed by specialists may not receive radioactive iodine therapy when they need it or do receive it when it is not indicated. Also, diagnosis of recurrence of thyroid cancer may be missed or delayed. Racial minority groups are more likely to receive cancer care from their PCPs (Primary Care Doctors) as opposed to specialists. This study was done to evaluate differences in the care of thyroid cancer received by minority groups by looking at who was delivering the care, specialists vs PCPs.

THE FULL ARTICLE TITLE
Radhakrishnan A et al 2021 Physician specialties involved in thyroid cancer diagnosis and treatment: Implications for improving health care disparities. J Clin Endocrinol Metab. Epub 2021 Oct 26. PMID: 34718629

SUMMARY OF THE STUDY
Patients and physicians responded to a survey. Patients with thyroid cancer diagnosed in 2014 and 2015 were identified from registries.

PCPs, defined as the doctors who were most involved in their thyroid cancer care, were named by their patients. Patients answered questions about their age, sex, race/ethnicity, income and health insurance. PCPs questionnaires included age, race/ ethnicity, how long have they been in practice, etc. Over 2600 patient and 162 physicians responded to the study. The majority were women, 20% self-identified as Hispanic, 11% as Black and 9% as Asian. Patients were more likely to find out about their cancer diagnosis by their surgeon (40%) and only 13 % by their PCP. But when compared by race, Hispanic patients were more likely to find out about their diagnosis from their PCPs. Other ethnic groups reported similar findings. Black and Asian patients were more likely to discuss treatment with their PCPs in comparison to White patients. In terms of age, the older the patient the more likely they were to discuss treatments with their PCP. Of the PCPs who reported discussing diagnosis and treatment of thyroid cancer, only about half of them felt comfortable discussing treatment options.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
In summary, in older patients and in patients from racial/ ethnic minority groups, PCPs were more likely to be engaged in the thyroid cancer care with less involvement of specialist. These findings may point out to inequalities in the care of patients with thyroid cancer and the barriers to seeing specialists. Programs to help facilitate timely PCP referrals to specialists and establishing satellite clinics in underserved areas may be beneficial in reducing these disparities. Educating the PCPs in thyroid cancer management will help them feel more comfortable treating their patients and in this way will result in better patient care.

— Susana Ebner MD

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