title: PRACTICAL BARRIERS TO IMPLEMENTATION OF THYROID CANCER GUIDELINES IN THE ASIA-PACIFIC REGION.
abstract: OBJECTIVE
  Numerous published guidelines have described the optimal management of thyroid cancer. However, these rely on the clinical availability of diagnostic and therapeutic modalities. We hypothesized that the availability of medical resources and economic circumstances vary in Asia-Pacific countries, making it difficult to implement guideline recommendations into clinical practice.
  
  
  METHODS
  We surveyed participants at the 2009 and 2013 Congresses of the Association of Southeast Asian Nations Federation of Endocrine Societies by distributing questionnaires to attendees at registration.
  
  
  RESULTS
  Responses were obtained from 268 respondents in 2009 and 163 respondents in 2013. Similar to the high prevalence of low-risk thyroid cancer observed in the Surveillance, Epidemiology, and End Results database, across the Asia-Pacific countries surveyed in 2009 and 2013, 50 to 100% of the respondents from the Philippines, Malaysia, Singapore, China, Taiwan, Thailand, Hong Kong, Korea, and Sri Lanka reported that more than 50% of the patients had low-risk thyroid cancer on follow-up. Importantly, there was much variation with regards to the perceived availability of investigation and treatment modalities.
  
  
  CONCLUSIONS
  We found a wide variation in clinicians' perception of availability of diagnostic and therapeutic modalities in the face of a rise in thyroid cancer incidence and thyroid cancer management guidelines that emphasized their importance. The lack of availability of management tools and treatments will prove to be a major barrier to the implementation of thyroid cancer management guidelines in Southeast Asia, and likely in other parts of the world as well.
authors.forename: Samantha Peiling
authors.initials: SP
authors.lastname: Yang
authors.forename: Lee Suat
authors.initials: LS
authors.lastname: Ying
authors.forename: Stephanie
authors.initials: S
authors.lastname: Saw
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
authors.forename: Kavita
authors.initials: K
authors.lastname: Venkataraman
authors.forename: Chia
authors.initials: C
authors.lastname: Su-Ynn
mesh_terms: D001210:Asia, Southeastern / Q000453:epidemiology; D044963:Biopsy, Fine-Needle / Q000592:standards / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D003144:Communication Barriers; D003952:Diagnostic Imaging / Q000379:methods; D004704:Endocrinology / Q000592:standards; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006284:Health Plan Implementation / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007194:India / Q000453:epidemiology; D009333:Neck / Q000000981:diagnostic imaging; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D056910:Republic of Korea / Q000453:epidemiology; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013960:Thyroid Function Tests / Q000592:standards / Q000706:statistics & numerical data; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013972:Thyrotropin / Q000032:analysis / Q000097:blood; D014463:Ultrasonography; D000078329:Workforce
chemical_list: D013972:Thyrotropin