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