Ellis Fischel Cancer Center Registry Data
2014 Outcome Study: Thyroid Cancer
To understand the thyroid cancer patient population at Ellis Fischel a retrospective review was performed to evaluate the presenting characteristics and outcomes of thyroid cancer patients at Ellis Fischel Cancer Center from 1998 to 2012.
Thyroid cancer is the most common endocrine cancer comprising slightly more than 95% of all cancers of endocrine system, and accounts for 2% of all cancers diagnosed in the United States. The incidence of thyroid cancer is increasing in the United States and around the world. Studies have shown difference in rates of incidence based on age, gender, race and socioeconomic status. Among the various types of thyroid cancer, papillary thyroid cancer has shown an increasing incidence over the last 4 decades in the US. Based on this trend the most recent SEER data indicates that there will be an estimated 62,980 new cases of thyroid cancer in the US in 2014, comprising 3.8% of all cancer cases. Most patients with thyroid cancer have an excellent prognosis with a low mortality. According to the SEER data there will be an estimated 1,890 deaths from thyroid cancer in 2014. However, this increasing incidence as well as increasing prevalence of patients with a diagnosis of thyroid cancer poses unique challenges to the clinicians including long-term follow-up plan for survivors, cost of care and maintenance of quality of life. It also poses questions to address the epidemiology to explain this increase in thyroid cancer as well as to evaluate the diagnostic and therapeutic challenges in a diverse population.
Treatment variables that contribute to outcome include appropriate initial diagnosis, extent of surgery, optimal radioactive iodine treatment and long term follow up based on individualized multidisciplinary care. In an effort to increase public awareness Ellis Fischel conducted head and neck cancer screenings annually. Once a patient is referred to Ellis Fischel they are evaluated in the Multidisciplinary Thyroid Clinic with ENT and Endocrinology care. Thyroid ultrasounds are performed by physicians and if needed an FNA is performed with a pathologist interpreting the cytology on site and providing the diagnosis. A nurse navigator provides education and support, and also co-ordinates surgery, radioactive iodine therapy and further testing as needed. This multidisciplinary approach is focused not only on acute treatment, but also on patient education and long term surveillance.
Ellis Cancer Registry data review was conducted in March 2014 and all cases of thyroid cancer were identified and reviewed regarding age and sex between 1998 and 2012. Survival was evaluated based on stage of cancer to information available from the National Cancer database between 2003 to 2006.
Thyroid cancer in Mid Missouri: A review of the Missouri Cancer Registry regarding thyroid cancer showed an increasing incidence of thyroid cancer in Mid Missouri consistent with the findings in the rest of the US. (Source Missouri Cancer Registry)
Distribution of patients: 489 patients with thyroid cancer were seen at Ellis Fischel between 1998 and 2012. The most common type of thyroid cancer was papillary thyroid cancer. 79 % of patients were diagnosed and treated at Ellis Fischel cancer center. Whereas 20 % of patients were referred to Ellis Fischel after being diagnosed elsewhere consistent with the referral and tertiary care provided by Ellis to the surrounding communities.
Age and Gender distribution: Most of the patients were women comprising 72 % of the groups. Thyroid cancer was most frequently diagnosed between the ages of 40-49 in our patient population. This age at diagnosis is younger compared to other Missouri hospitals as well as the national data in SEER. The exact reason for this is unclear at this time. This may represent earlier detection based on easier access to advanced diagnostic testing including neck ultrasounds available in Mid Missouri. However further studies may help to clarify this also. Although women showed a higher incidence at every age, we also found that more men were diagnosed after the age of 45 years.
Stage of Thyroid Cancer and Survival: Thyroid cancer data for staging was reviewed from 2003 to 2006. Most of the patients were diagnosed at stage 1. This information was compared to patients in the National Cancer database. Thyroid cancer patients treated at Ellis Fischel showed similar 5 year survival compared to NCD at stage 1, 2, and 3. The 5 year survival for stage 4 patients shows a slightly better outcome, however the numbers are small and the findings may be biased.
Ellis Fischel Cancer Center is a tertiary care academic center focused on excellence in prevention, diagnosis, treatment and research to improve the life of cancer patients. Since 2006 the multidisciplinary thyroid clinic at Ellis Fischel has focused on improving clinical care for patients with thyroid cancer.
Our review of thyroid cancer statistics confirms the increasing incidence of thyroid cancer in Mid-Missouri. Most of these patients are young women with an excellent survival. However there is still a small group of patients with advanced stage thyroid cancer that shows poor survival. The management of these patients is done by a team including oncology, surgery, endocrinology and nuclear medicine. Ellis Fischel is collaborating with the Missouri Cancer registry to understand the prevalence of thyroid cancer in Missouri. In an effort to accurately identify patients with thyroid cancer preoperatively and preventing unnecessary surgery, advanced testing for molecular and characteristics in thyroid aspiration are being performed. In patients with advanced stage cancer and poor survival, new advances in medical therapy and the study of genetic markers and mutations is a significant advancement. Ellis Fischel has multiple active research projects focused on these patients. Current studies include collaborative projects with the Mid West Head and Neck Cancer Consortium and the University of Missouri radiology and bioengineering departments to focus on identifying and treating this group of patients to improve outcome.