Age disparities in referrals to specialist surgical care for papillary thyroid cancer.
OBJECTIVE
Referrals to specialist surgical care for papillary thyroid cancer are significantly influenced by patient age and the presence of lymph node metastases. This study sought to clarify whether younger patients with papillary thyroid cancer are referred more often because of their more frequent and more numerous lymph node metastases or because of age alone.


METHODS
Analysis of 832 consecutive patients with papillary thyroid cancer referred to a tertiary surgical center in Germany between 1994 and 2009.


RESULTS
Age (especially when categorized at 30 years) and lymph node metastases were independently associated with referral distance. Younger age was consistently correlated with greater referral distance. The effect of age was stronger in node-negative patients referred for initial operations and weaker in node-positive patients referred for reoperations. Conversely, lymph node metastases were associated with greater travelling distance, more in older than younger patients referred for reoperations, but did not seem to play any role in referrals for initial operations.


CONCLUSIONS
Despite their better prognosis, younger patients with papillary thyroid cancer were referred to specialist care across significantly greater distances, regardless of their lymph node status, than older patients who have a worse prognosis. The causes underlying these age disparities in referrals to specialist care warrant further research.
Machens
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A
Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle, Saale, Germany. andreasmachens@aol.com
Dralle
H
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002291:Carcinoma, Papillary / Q000601:surgery*; D002648:Child; D005260:Female; D005858:Germany; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D013043:Specialties, Surgical; D013964:Thyroid Neoplasms / Q000601:surgery*