title: Regional differences in opinions on adjuvant radioactive iodine treatment of thyroid carcinoma within Canada and the United States.
abstract: OBJECTIVE
  To identify regional differences in recommendations for radioactive iodine remnant ablation (RRA) in early stage well-differentiated thyroid carcinoma (WDTC) within Canada and the United States.
  
  
  METHODS
  A cross-sectional written survey of a sample of physicians in specialties potentially involved in thyroid cancer care was performed in 2006. Participants were asked if they recommended RRA for a hypothetical 38-year-old woman with a solitary, 1.6-cm papillary carcinoma resected by total thyroidectomy. Exploratory regional comparisons were performed using Student t tests or analysis of variance. The regions studied were western Canada, eastern Canada (Ontario, the Maritimes), Quebec, the northeastern United States, the western and midwestern United States, and the southern United States. In a secondary multivariable logistic regression analysis, we explored potential relationships between individual respondent characteristics RRA recommendations.
  
  
  RESULTS
  Agreement with case-based RRA recommendations was measured on a Likert scale of 1 to 7 (7 = strongest agreement).
  
  
  RESULTS
  The effective response rate was 56.3% (486/864). There were significant differences in RRA recommendations among the regions studied (F = 11.99, 5 df, p < 0.001); national boundaries did not explain regional variations. For the sample case, the strongest support for RRA was in Quebec and the southern United States, intermediate support in eastern Canada and the northeastern United States, and the least support in western Canada and the western and midwestern United States. Academic affiliation and surgical specialty were independently inversely associated with strong RRA recommendations.
  
  
  CONCLUSIONS
  There are significant regional differences in physician-based RRA recommendations in early stage WDTC within Canada and the United States. Physician specialty and practice characteristics may influence RRA recommendations.
authors.affiliation: Division of Endocrinology and Department of Medicine, University Health Network Toronto, Ontario, Canada. sawkaam@yahoo.com
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sawka
authors.forename: Lorne
authors.initials: L
authors.lastname: Rotstein
authors.forename: James D
authors.initials: JD
authors.lastname: Brierley
authors.forename: Richard W
authors.initials: RW
authors.lastname: Tsang
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Sharon
authors.initials: S
authors.lastname: Straus
authors.forename: Shamila
authors.initials: S
authors.lastname: Kamalanathan
authors.forename: Boyu
authors.initials: B
authors.lastname: Zhao
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Gloria
authors.initials: G
authors.lastname: Rambaldini
authors.forename: Shereen
authors.initials: S
authors.lastname: Ezzat
mesh_terms: D000328:Adult; D002170:Canada; D002291:Carcinoma, Papillary / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D014481:United States
chemical_list: D007457:Iodine Radioisotopes