World Journal of Endocrine Surgery

Register      Login

VOLUME 13 , ISSUE 2 ( May-August, 2021 ) > List of Articles


Failure to Intervene on Thyroid Cancer: A Study of the National Cancer Database

Megan K Applewhite, Michael G White, Edwin L Kaplan, Peter Angelos, Raymon H Grogan

Keywords : Disparity, Failure to intervene, Insurance, NCDB, Race, Thyroid Cancer, Travel

Citation Information : Applewhite MK, White MG, Kaplan EL, Angelos P, Grogan RH. Failure to Intervene on Thyroid Cancer: A Study of the National Cancer Database. World J Endoc Surg 2021; 13 (2):47-52.

DOI: 10.5005/jp-journals-10002-1405

License: CC BY-NC 4.0

Published Online: 31-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Background: The concept of failure to intervene (FTI) was introduced in the context of pancreatic cancer patients with an operable malignancy, who did not undergo surgery. Here, we investigate FTI in the thyroid cancer population. We define patients with operable thyroid cancer with FTI, define risk factors for FTI, and evaluate overall survival. Materials and methods: Patients with histologic codes corresponding to papillary, follicular, or medullary thyroid cancer in the National Cancer Database were identified and divided into three categories: “FTI,” “No Surgery: Intentional (NSI),” and “Surgery.” Risk factors for FTI were studied using univariate and multivariate logistic regression. Survival differences were studied using Cox Hazards modeling. Results: Of those studied, 294,088(96.6%) underwent surgery, 8,939(2.9%) were NSI, and 1,579(0.5%) were FTI. Those in the FTI group were older than the surgery group, more likely to be male, black, have Medicare, or be uninsured [all p < 0.001]. Independent risk factors for FTI were: lack of insurance [OR = 3.79 (2.98–4.82), p < 0.001], stage IVc disease [OR = 3.98 (3.11–5.09), p < 0.001], and Asian [OR = 1.98 (1.56–2.52), p < 0.001] or Black race [OR = 2.08 (1.73–2.50), p < 0.001]. There was a significant overall survival advantage for the surgery group as compared to the NSI [Cox Hazard Ratio = 3.7 95% CI (3.3–4.1), p < 0.001] and FTI groups [Cox Hazard Ratio = 7.0 95% CI (6.7–7.2), p < 0.001]. Conclusion: Nearly 97% of thyroid cancer patients in the United States undergo surgical resection. Not having a surgical resection corresponds to a decrease in survival. Non-white race and lack of insurance were risk factors for FTI. Further work needs to be done to identify and appropriately treat this subset of patients who would benefit from resection.

  1. Bilimoria KY, Bentrem DJ, Ko CY, et al. National failure to operate on early stage pancreatic cancer. Ann Surg 246 2007;(2):173–180. DOI: 10.1097/SLA.0b013e3180691579
  2. Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg 1996;223(3):273–279 DOI: 10.1097/00000658-199603000-00007
  3. Endorsement Summary: Cancer Measures. October 23, 2012. National Quality Forum. Washington, DC
  4. StataCorp. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013.
  5. Loyo M,Tufano RP, Gourin CG. National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope 2013;123(8):2056–2063. DOI: 10.1002/lary.23923
  6. Sosa JA, Mehta PJ, Wang TS, et al. Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg 2007;246(6):1083–1091. DOI: 10.1097/sla.0b013e31812eecc4
  7. Walker GV, Grant SR, Guadagnolo BA, et al. Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. J Clin Oncol 2014;32(28):3118–3125. DOI: 10.1200/JCO.2014.55.6258
  8. Loehrer AP, Chang DC, Hutter MM, et al. Health insurance expansion and treatment of pancreatic cancer: does increased access lead to improved care? J Am Coll Surg 2015;221(6):1015–1022. DOI: 10.1016/j.jamcollsurg.2015.09.010
  9. Bilimoria KY, Stewart AK, Winchester DP, et al. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008;15(3):683–690. DOI: 10.1245/s10434-007-9747-3
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.