Non-Adherence to Guidelines May Lead To Inappropriate Radioactive Iodine Treatment for Thyroid Cancer

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Sanziana Roman MD FACS Professor of Surgery Duke University  Section of Endocrine Surgery Director of the Endocrine Surgery Fellows and Scholars Program Duke University School of Medicine Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMCMedicalResearch.com Interview with:
Sanziana Roman MD FACS

Professor of Surgery Duke University
Section of Endocrine Surgery
Director of the Endocrine Surgery Fellows and Scholars Program
Duke University School of Medicine
Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMC

Medical Research: What is the background for this study?

Dr. Roman: Adjuvant radioactive iodine (RAI) is commonly used in the management of differentiated thyroid cancer. The main goals of adjuvant RAI therapy are to ablate remnant thyroid tissue in order to facilitate long-term follow-up of patients, decrease the risk of recurrence, or treat persistent and metastatic lesions.

On the other hand, Adjuvant radioactive iodine ( therapy is expensive, with an average cost per patient ranging between $5,429.58 and $9,105.67. It also carries the burden of several potential complications, including loss of taste, nausea, stomatitis with ulcers, acute and/or chronic sialoadenitis, salivary duct obstruction, dental caries, tooth loss, epiphora, anemia, neutropenia, thrombocytopenia, acute radiation pneumonitis, pulmonary fibrosis, male infertility, and radiation-induced malignancies. Therefore, Adjuvant radioactive iodine ( should be used only for appropriately selected patients, for whom the benefits would outweigh the risks.

Based on current guidelines, adjuvant RAI is not recommended for patients with papillary thyroid cancers confined to the thyroid gland when all foci are ≤1 cm (papillary thyroid microcarcinoma, or PTMC). Similarly, Adjuvant radioactive iodine ( does not have a role in the treatment of medullary and anaplastic thyroid cancer. Given the fact that variation in treatments exist, our goal was to analyze patterns of inappropriate adjuvant RAI use in the U.S. in order to identify potential misuses leading to an increase of costs for the healthcare system and unnecessary patients’ exposure to risks of complications.

Medical Research: What are the main findings?

Dr. Roman: We demonstrated in two separate U.S. national databases, which encompassed >85% of all incident thyroid cases in the U.S. and more than 28% of the population, that nearly 16% of patients with papillary thyroid microcarcinoma, 4% of those with medullary thyroid cancers, and 2% of those with anaplastic thyroid cancers undergo unnecessary RAI therapy, with an estimated cost burden of $9,599,497-16,098,824 per year for papillary thyroid microcarcinoma treatment only. This cost is likely an underestimation, since we could not include in our analysis costs associated with possible RAI complications and quality of life changes, and that our reported costs are based on Medicare reimbursements, which are likely to be lower than private insurances rates. Additionally, we identified that certain patient factors, such as having low income, receiving care in non-academic facilities, and having multifocal and larger thyroid tumors were associated with an increased risk of receiving inappropriate RAI after a papillary thyroid microcarcinoma diagnosis.

Medical Research: What should clinicians and patients take away from your report?

Dr. Roman: There is good evidence that practice guidelines have a positive impact on the outcome of patients with thyroid cancer; guidelines regarding the appropriate use of Adjuvant radioactive iodine are important in providing a platform for improved care. This study highlights the importance of better dissemination of national practice guidelines among health care providers and centers, especially in areas who serve vulnerable patients populations.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Roman: Future research should be oriented towards identifying reasons for non-adherence to guidelines and determining better ways of disseminating knowledge on adjuvant radioactive iodine therapy recommendations for non-academic health care teams, in order to improve patient care.

Citation:


MedicalResearch.com Interview with:, & Sanziana Roman MD FACS (2015). Non-Adherence to Guidelines May Lead To Inappropriate Radioactive Iodine Treatment for Thyroid Cancer MedicalResearch.com

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