Study Reassures Transition From Specialist to PCP After Thyroid Cancer Treatment

More than half of patients with thyroid cancer transitioned from a specialist to their primary care provider after participating in a primary care-based follow-up program, according to a poster presentation at the 91st Annual Meeting of the American Thyroid Association.

“With the rising incidence of thyroid cancer, the increased need for post-treatment follow-up among survivors, and the limited number of thyroid cancer specialists, there is an opportunity for primary care physicians to play a larger role in providing follow-up care in Ontario Canada,” Patricia Nguyen, PhD, Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Canada, said in a presentation of the data.

While the 5-year survival rate among patients is promising, at 98%, according to investigators, the vast majority will have to transition back to a primary care provider.

“Recently-published clinical pathways for thyroid cancer treatment outlined the criteria for transitioning low-risk patients to primary care [physicians] within 1 to 5 years from diagnosis; however, discharge patterns among endocrinologists remain heterogeneous as there [is a] lack [of] consensus regarding post-treatment care for thyroid cancer patients,” Nguyen said.

Although long-term follow-up by an endocrinologist is the most common practice, limited knowledge remains around the role of the primary care physician in thyroid cancer follow-up.

Therefore, investigators aimed to describe outcomes of patients with thyroid cancer who were transitioned from a specialist to a primary care provider after treatment.

The retrospective, observational study identified 148 eligible patients with thyroid cancer from the After Cancer Treatment Transition (ACTT) clinic, where patients are referred and go on to receive care from a general practitioner and an advanced practice nurse. Data were collected through chart review.

The mean age of patients was 55 years (range, 29-80), and overall mean age at thyroid cancer diagnosis was 43 years (range, 18-70). The majority of patients were female (76%); had T₂ (42%), N₀ (55%), M₀ (91%), and stage 1 (83%) disease; and all patients had papillary thyroid cancer.

The majority of patients underwent total thyroidectomy (68%), while 31% received a 2-stage process, and 1% had a hemithyroidectomy. In addition, 64% received additional treatment with

radioactive iodine.

The mean time from diagnosis and the first visit to the ACTT clinic was 4.5 years (range, 1-15).

Mean levels for thyroglobulin ([0.64; 95% CI, 0.04-4.5] vs [0.53; 95% CI, 0.01-18], respectively) and thyroglobulin antibodies ([18.87; 95% CI, 10-156] vs [15.11; 95% CI, 8.84-92]), were overall low from first ACTT visit and latest ACTT visit. Moreover, mean levels of thyroid stimulating hormone ([1.37; 95% CI, 0.01-18.14)] vs [1.42; 95% CI, 0.01-15.9], respectively), free thyroxine ([19.17; 95% CI, 2.31-33] vs [19.49; 95% CI, 4.17-33]), and calcium ([2.52; 95% CI, 1.26-2.6] vs [2.32; 95% CI, 0.25-2.56]) were within normal range between first and last visit.

Two cases of thyroid cancer recurrence occurred (1.2%). However, as of the presentation, no other patients have required re-referral to specialist care as a result of a recurrence being identified.

“Overall, the study cohort was low-risk and stable, with excellent response to therapy and met the criteria for transition from specialist to primary care. Recurrence was very low, and the 2 cases of recurrence had incomplete response to therapy and were likely not appropriate candidates for transition to primary care,” Nguyen explained.

Overall, 53% of patients have been discharged from the ACTT clinic, and they have fully transitioned to their primary care provider.

“It was encouraging that all other patients with complete response to therapy showed no evidence of disease recurrence and have not required a re-referral back to specialist care,” Nguyen concluded. “Our findings may provide endocrinologists with more reassurance in transitioning thyroid cancer patients post-treatment to primary care.”

Reference:

Nguyen P, Azizi-Mehr P, Townsley C, Zahedi A. Outcomes of early transition of low-risk thyroid cancer patients from specialist to primary care. Thyroid. 2022;32(1):P-1-A-135. doi:10.1089/thy.2022.29137.abstracts.