The Road to Overcoming Disparities in Thyroid Cancer Care

Megan R. Haymart, MD

Research has shown that patients with thyroid cancer receive different care based on race/ethnicity, gender, and socioeconomic status.1 Such disparities are seen across the healthcare industry, and organizations like the American Thyroid Association (ATA) are working to do their part in finding solutions.

At the ATA 2022 Annual Meeting, experts gathered for a symposium during which 3 presentations were given around disparities in access to care. One presentation given by Megan R. Haymart, MD, focused on strategies to overcome the disparities.

In an interview with Targeted Oncology™, Haymart, professor of medicine, Division of Metabolism, Endocrinology, and Diabetes, and Hematology/Oncology, provided a recap of the symposium and discussed disparities in thyroid cancer care, as well as potential solutions.

TARGETED ONCOLOGY™: Can you give an overview of your presentation from the ATA Annual Meeting?

Haymart: I was part of a symposium that talked about disparities in thyroid care. My specific lecture talked about strategies for improvement. One of the mottos of the American Thyroid Association is optimal thyroid health for all, and that implies equity and inclusion. I think it's very important for the American Thyroid Association to follow those words and come up with opportunities to improve the care of all patients who have thyroid disorders.

During my discussion, I highlighted some potential strategies. Some of these have been outlined by peers and are very thyroid specific. Other strategies have been outlined at a national level, and are broader than just thyroid, but encompassing other conditions, as well, and specifically being related to how we can improve research to improve thyroid care. Or, they are related clinical trials and how we can do more for inclusion and representation.

What disparities are you seeing in thyroid cancer right now? What is contributing to the issue of inequity?

We know that there's differences in outcomes related to race and ethnicity, as well as socioeconomic status. Some of the reasons why this may occur is if patients are not seeing high-volume physicians. There's been very strong data for surgery, and then some recent data regarding medical management, showing that outcomes are improved if you're seeing a high-volume physician. If everyone doesn't have access, this becomes an issue. That is why 1 of our strategies is starting a conversation on how we can do more to improve access, including transportation issues, [and seeing] if telemedicine is going to be an optimal way to improve cancer. We want to make sure that everyone who needs care can receive the best care.

How do you think disparities in thyroid cancer are impacting patient care?

Some of our prior work has found that worry is higher in young adults as well as in minority patients. I do think that if patients have adverse outcomes, that can contribute to worry. If patients don't receive optimal educational material, that can contribute to worry. I think that it can be multifactorial, but I think that there's more that we can do at the American Thyroid Association to improve thyroid health for all.

Is there any ongoing research that can help oncologists understand these disparities better?

Some of my colleagues are taking a multipronged approach to this. That involves looking at big databases to understand disparities, conducting more survey studies, and generating patient reports. Then, 1 of my colleagues is also looking a little bit more into language disparities, and how we can make sure that we improve access to all by making sure the information available in patients’ preferred languages.

What are some of your ideas to close the disparities gap in thyroid cancer?

The session at the ATA Annual Meeting was a brainstorming session, and this is just the start of the discussion. There's a lot that we can do to make improvements and it'll be up to the ATA and leaders in thyroid to consider what would be the next best step.

One of the things that I think we have to look at is access. How can we do more in regard to access, whether that's meeting transportation needs or mobile health? Some of the issues are related to research, so, how can we do more in research? We know that for trials within thyroid as well as other conditions, there needs to be more diversity and inclusion. How can we incentivize better representation in clinical trials. In research, we also know that there's more that we can do regarding reporting. Sometimes there are diverse cohorts, but there's not a separate analysis by sex or race, there is just sort of dive deep. We must find out if there are additional obstacles that individuals are facing. Some of that can be how we can use the same data and look at it more in depth.

What are you overall thoughts about the importance of the ATA disparities efforts?

I think it's encouraging that last year we had a disparities lecture at the ATA Annual Meeting and then this year, they've incorporated the idea of strategies. Again, it’s an early brainstorming effort, but I think it's very important that if the ATA’s motto is optimal thyroid health for all, equity and inclusion have to be central to everything the organization does. I think it's very encouraging that they're looking at this issue in more depth. This is a first step and there is more to come.

_REFERENCE:

_{Haymart M. Strategies for overcoming barriers to specialty care for thyroid disease and cancer. Presented at: ATA 2022 Annual Meeting; October 19-23, 2022; Montreal, QC.}