thyroid cancer care Archives

Advancing Thyroid Cancer Care: Tailored Treatment and Patient Involvement from Patient Empowerment Network on Vimeo.

What are some ways that thyroid cancer care is being advanced? Expert Dr. Megan Haymart from the University of Michigan discusses updates in thyroid cancer guidelines, shared decision-making, and actionable patient advice for personalized treatment.

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“…patients should carefully ask the risks and benefits of each of the treatment options, so they can make a pro/con list for themself and really tailor it to what’s a priority to them.”

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Transcript:

Lisa Hatfield:

Dr. Haymart, with your involvement in creating thyroid carcinoma guidelines and your research on optimizing cancer care delivery, what recent advancements or changes in thyroid cancer management do you find most promising for improving patient outcomes?

Dr. Megan Haymart:

So I think there are a lot of exciting changes that are coming. But the one that I’m the most excited about with the guidelines is the guidelines are going to emphasize tailored care more and shared decision-making more. And so I think these are key. And so for a lot of thyroid cancer management, there is not one right or wrong treatment option. It depends a little bit on the patient and what their preferences are.

And so for preference sensitive decision-making, there’s going to be a lot more emphasis on including the patient in that decision-making. There’s no right or wrong choice. The patient can think about what concerns them the most and then prioritize things based on that.

So, for example, total thyroidectomy, which means removing all of the thyroid versus lobectomy, which removes half the thyroid. For some patients with low-risk disease, either option is okay. The benefit of doing a lobectomy is there’s less surgical risk, so less risk of voice problems, less risk of low calcium. The disadvantage is that sometimes there’s more follow-up needed, maybe more ultrasounds needed. You don’t know by blood work necessarily that all the cancer’s gone. So you get more information by doing the total thyroidectomy but the total thyroidectomy has more surgical risk.

So, for example, if someone is a singer and they really don’t want their voice to be damaged and they’re not that worried about cancer coming back, lobectomy might be the choice for them. If someone has a lot of anxiety about wanting to know that absolutely everything is gone and the idea that they might need more ultrasounds makes them anxious, maybe total thyroidectomy would be a better option for them.

And so moving forward, I think there’s going to be this emphasis on personalized care, shared decision making and sort of tailoring the care to the patient. And so my activation tip for this question is that patients should carefully ask the risks and benefits of each of the treatment options, so they can make a pro/con list for themself and really tailor it to what’s a priority to them.

Lisa Hatfield:

Okay. Thank you. And one follow-up question I have to that as a cancer patient myself is, whether a patient and their doctor chooses a more or less aggressive treatment with their thyroid cancer, what does the follow-up look like? Are labs and imaging done forever for that patient to make sure there’s not a recurrence or is it just for a certain period of time?

Dr. Megan Haymart:

So this is a great question. About, I don’t know, 10 years ago everybody was getting almost the same treatment, right? So we’ve started to tailor it more and there’s far more people getting lobectomy now than they were 10, 20 years ago. Which is great. The disadvantages, we don’t have as much long-term data on these individuals.

And so it’s a little hard to be conclusive about when is the right time to stop follow-up. The longer we get out, the more data we’ll have on how long we need to follow these patients who had lobectomy, but I think that’s an excellent question. It’s just the fact that there’s been a shift in management and we haven’t had time to catch up to like, how should surveillance or long-term survivorship care change.

Transcript:

Lisa Hatfield:

Dr. Haymart, what are the current barriers that disadvantaged patient populations face in receiving a timely diagnosis and, even more important, treatment of their thyroid cancer?

Dr. Megan Haymart:

So there are disparities in the care of thyroid cancer patients from diagnosis to treatment and even survivorship. For diagnosis, we know that there are certain groups that are at higher risk for presenting with advanced stage disease, so especially minority populations, Black and Hispanic. We don’t know why that is. We don’t fully know why that is at least, but my activation tip for diagnosis would be that if you feel a lump in your neck that doesn’t go away after a few weeks, especially lower in your neck, talk to your doctor.

We also see disparities in treatment. And I think we know a little bit more about why those occur. So there’s been recent data by Dr. Chen, who works with my group, who found that when patients call to get into the clinic, if they don’t speak English as their primary language, if they speak Spanish or Mandarin, they may have difficulty getting into the clinic for a visit. And so we think there are language barriers that occur.

We also know that there’s differences in treatment based on what doctors patients are seeing. So if patients are seeing low volume surgeons who don’t do a lot of operations, they may not get the best treatment for them, which could lead to downstream consequences, including increased risk of recurrence or complications from the surgery itself.

And so my activation tip for this question is that if English is not your primary language and if you run into obstacles scheduling an appointment, if you have any family members or friends that speak English that you can pull in to help you, I think that’d be important. Hopefully, eventually the system will be better where that’s no longer an obstacle, but for now I think that’s important to know.

And then my other activation tip for this question is, you want to make sure you know who your surgeon is in regards to if they’re a high or low volume surgeon. That’s extremely tricky to know, even for me as a physician. I know thyroid cancer because I do thyroid cancer, but if you asked me about GI cancer, I wouldn’t know. And so you have to ask your surgeon, how many operations have you done within the past year? High volume surgeons typically do 25 or more. And so I think that’s really important because you’re going to have a lower risk of complications. And so I would encourage all patients to speak up and to make sure they ask these questions.

Lisa Hatfield:

Okay, thank you. Would it be appropriate for a patient to ask specifically how many of those surgeries that physician has done every year?

Dr. Megan Haymart:

Yeah, it’s totally appropriate to ask because you can’t find that information on the web. So unless you have a doctor colleague or a friend who knows thyroid well, and knows who those high volume surgeons are, they might be able to identify them. But otherwise, if you’re just referred to your local surgeon, I think it’s very appropriate to ask them, how many surgeries have you done in the past year? What are some of the complications that might happen? How often do you see that in your patient setting? I think those would be very appropriate questions.

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