February 17, 2015 – Julie Sosa, MD, and her colleagues found that many patients receive adjuvant radioactive iodine treatment in contravention of current guideline recommendations.
Nearly a quarter of thyroid cancer patients may be receiving unnecessary adjuvant radioactive iodine (RAI) treatment, according to a new study by DCRI and Duke researchers published online this week in the journalJAMA Internal Medicine.
The study, conducted by Paolo Goffredo, MD; Samantha Thomas, MB; Michaela Dinan, PhD; Jennifer Perkins, MD; Sanziana Roman, MD; and Julie Sosa, MD (pictured), suggests that overuse of RAI is contributing to healthcare costs and exposing cancer patients to unnecessary risk.
Current guidelines do not recommend RAI for localized papillary thyroid tumors measuring 1 cm or less, medullary thyroid cancer, or anaplastic thyroid cancer. Earlier studies, however, have indicated that RAI is often used to treat such conditions. To understand the larger pattern of RAI use in the United States, the researchers used the National Cancer Data Base to obtain treatment information on patients diagnosed with medullary thyroid cancer, anaplastic thyroid cancer, and papillary thyroid cancer between 1998 and 2011.
All adult patients with medullary and anaplastic thyroid cancer were included in the analysis. Adult patients with papillary thyroid cancer with papillary thyroidmicrocarcinoma measuring 1 cm or less, no aggressive histologic variants, no extrathyroidal extension, no regional or distant metastases, and negative margin status were also included. Cost estimates were obtained from the Centers for Medicare and Medicaid Services and the Bureau of Labor Statistics.
The researchers found that 49 of 3,095 anaplastic thyroid cancer patients (1.6 percent), 217 of 6,375 medullary thyroid cancer patients (3.4 percent), and 14,146 of 60,586 papillary thyroid cancer patients (23.3 percent) received RAI in contravention of guideline recommendations. The cost for these unnecessary procedures was estimated between $5,587.73 and $8,442.11 per patient in 2011 ($5,429.58 and $9,105.67 in 2014 dollars). The average total number of patients was 1,768 per year, with a total cost of $9,879,109 to $14,925,650 per year in 2011 dollars ($9,599,497 to $16,098,824 per year in 2014 dollars.)
The researchers cautioned that these figures are probably conservative, as they were unable to account for costs associated with complications from RAI treatment and related quality of life issues. They also noted that the rate of unnecessary RAI treatment decreased overall during the time period studied; but no change was observed at community hospitals. This finding emphasizes the need to educate health care professionals about evidence-based practice guidelines, particularly professionals that serve areas with vulnerable populations, they concluded.