title: Variation in the management of thyroid cancer.
abstract: BACKGROUND
  Little is known about practice patterns in thyroid cancer, a cancer that is increasing in incidence.
  
  
  OBJECTIVE
  We sought to identify aspects of thyroid cancer management that have the greatest variation.
  
  
  METHODS
  We surveyed 944 physicians involved in thyroid cancer care from 251 hospitals affiliated with the US National Cancer Database. Physicians were asked questions in the following four domains: thyroid surgery, radioactive iodine use, thyroid hormone replacement postsurgery, and long-term thyroid cancer management. We calculated the ratio of observed variation to hypothetical maximum variation under the assumed distribution of the response. Ratios closer to 1 indicate greater variation.
  
  
  RESULTS
  We had a 66% response rate. We found variation in multiple aspects of thyroid cancer management, including the role of central lymph node dissections (variation, 0.99; 95% confidence interval [CI], 0.98-1.00), the role of pretreatment scans before radioactive iodine treatment (variation, 1.00; 95% CI, 0.98-1.00), and all aspects of long-term thyroid cancer management, including applications of ultrasound (variation, 0.97; 95% CI, 0.93-0.99) and radioactive iodine scans (variation, 0.99; 95% CI, 0.97-1.00). For the management of small thyroid cancers, variation exists in all domains, including optimal extent of surgery (variation, 0.91; 95% CI, 0.88-0.94) and the role of both radioactive iodine treatment (variation, 0.91; 95% CI, 0.89-0.93) and suppressive doses of thyroid hormone replacement (variation, 1.00; 95% CI, 0.99-1.00).
  
  
  CONCLUSIONS
  We identified areas of variation in thyroid cancer management. To reduce the variation and improve the management of thyroid cancer, there is a need for more research and more research dissemination.
authors.affiliation: Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA. meganhay@umich.edu
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Di
authors.initials: D
authors.lastname: Yang
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: James C
authors.initials: JC
authors.lastname: Sisson
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Koenig
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Doherty
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004704:Endocrinology; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision; D008297:Male; D008495:Medical Oncology; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009683:Nuclear Medicine; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013043:Specialties, Surgical; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014481:United States; D014837:Voluntary Health Agencies; D000078329:Workforce
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
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