An analysis of waiting times in patients with thyroid cancer. Issue 6 (December 2020)

• Record Type: Journal Article
• Authors: Gardner, Dominic; Nixon, Iain J.
• Is Part Of: Surgeon. Volume 18:Issue 6(2020)
• Page Start: e51
• Page End: e54
• Publication Date: 2020-12
• Subjects: Humans -- Carcinoma -- Papillary -- Adenocarcinoma -- Follicular -- Biopsy -- Fine needle -- Referral and consultation -- Thyroid neoplasms -- Primary health care; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2020.06.006
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Background: Scottish guidelines suggest that following a referral with a suspicion of cancer, patients should have a diagnosis within 31 days and commence treatment within 62 days. Thyroid cancer is not included in these targets. This study investigates the timelines of management of thyroid cancer, looking at factors that affect time to treatment and diagnosis in our network. Methods: The study was a review of a prospectively held database of patients discussed at MDT meetings between January 2016 and September 2018. Of the 153 potentially suitable thyroid cancer patients in NHS Lothian, 62 were eligible for inclusion in the study, having been referred to secondary care by their general practitioner (GP) and diagnosed with differentiated thyroid cancer (DTC). Results: At present only 10% and 16% of patients would meet the 62-day treatment and 31-day diagnosis targets respectively. The time to both diagnosis (p=<0.0005) and treatment (p = 0.022) is significantly improved in patients that have a diagnostic biopsy or FNA (Thy5) or a highly suggestive FNA (Thy4), compared with those that do not. There is no significant effect of GP referral type on time to diagnosis or management of thyroid cancer. With a median follow-up of 33 weeks, only one patient had died. Conclusions: Thyroid cancer does not fit the classical cancer targets well. It is a relatively indolent form of cancer, with many cases diagnosed either incidentally or after undergoing treatment. It is important to balance the resource implications of providing rapid treatment with the psychological effects of the diagnosis. Highlights: Scottish waiting time targets would not be met if applied to thyroid cancer. Referral priority from primary care did not affect time to treatment or diagnosis. A diagnostic pre-surgical biopsy significantly reduced time to treatment. Indolent disease biology and high incidental rate make targets impractical.