title: Best supportive care from the conservative/non-surgical perspective and its costs in the treatment of patients with advanced medullary thyroid cancer: results of a Delphi panel.
abstract: BACKGROUND
  Medullary thyroid cancer (MTC) is a rare tumor entity. The contents of best supportive care (BSC) have not been defined in advanced MTC. The objective of this work is to describe the epidemiology, the treatment patterns with respect to symptom management, as well as palliative treatment and associated costs.
  
  
  METHODS
  A Delphi panel with 9 clinical experts experienced in treating MTC was conducted to obtain details on the epidemiology of MTC and to gain insights into the therapeutic options considered for BSC in advanced MTC in Germany. Unit costs were applied to the described resources from the perspective of the German National Healthcare System in 2011.
  
  
  RESULTS
  The annual incidence of MTC in Germany was estimated at about 220. 32% of all patients were estimated to have aggressive/symptomatic MTC, with an estimated mean survival of 36.7 months (median: 36 months). The core element of BSC is relief of symptoms to maintain quality of life. The total mean cost of BSC per patient/year was estimated at € 9,248, lifetime cost at € 28,283.
  
  
  CONCLUSIONS
  There was consistent agreement within the panel on the epidemiology of MTC and on the structure of the provided therapeutic measures for BSC in advanced MTC, also defining the management of symptoms as a crucial goal of treatment.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Wuerzburg, Germany.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kreissl
authors.forename: Christian
authors.initials: C
authors.lastname: Jacob
authors.forename: Dagmar
authors.initials: D
authors.lastname: Führer
authors.forename: Wolfram
authors.initials: W
authors.lastname: Karges
authors.forename: Markus
authors.initials: M
authors.lastname: Luster
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittendorf
authors.forename: Matthias
authors.initials: M
authors.lastname: Schott
authors.forename: Christine
authors.initials: C
authors.lastname: Spitzweg
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schmoll
mesh_terms: D018278:Carcinoma, Neuroendocrine; D003697:Delphi Technique; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D010166:Palliative Care / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D013965:Thyroidectomy / Q000191:economics; D016896:Treatment Outcome