title: National Trends in the Surgical Treatment of Non-advanced Medullary Thyroid Cancer (MTC): An Evaluation of Adherence with the 2009 American Thyroid Association Guidelines.
abstract: Medullary thyroid cancer (MTC) represents the third most common type of thyroid cancer, and the prognosis depends on the stage of the disease at diagnosis and completeness of tumor resection. In 2009, the American Thyroid Association (ATA) published guidelines with evidence-based recommendations for the treatment of MTC. This study aimed to determine national adherence rates of the treatment according to the ATA guidelines specific for MTC.
  
  
  
  Patients diagnosed with MTC from 2004 to 2013 were identified from the National Cancer Database. Guideline adherence rates for the treatment of MTC before and after the publication of ATA guidelines were analyzed and compared to determine patient and clinical variables that affected treatment.
  
  
  
  A total of 3693 patients diagnosed with MTC were identified. We found 60.3 % of the patients had localized MTC and 39.7 % had regional metastases. Older age, female sex and having Medicaid or being uninsured were directly correlated with more advanced disease upon diagnosis (p < 0.001). Overall, a greater proportion of patients received care in accordance with the recommendations following the ATA guidelines' publication in 2009: 61.4 % of patients treated between 2004 and 2008 versus 66.8 % of patients treated between 2009 and 2013 received care in accordance with the recommendations (p < 0.01). Factors such as older age, African American race, localized disease at diagnosis, lower estimated median zip code household income and being treated in a community versus an academic hospital were associated with a lower likelihood of receiving care in accordance with the guidelines.
  
  
  
  Adherence rates to the ATA recommendations for the treatment of MTC increased modestly following the publication of guidelines in 2009 with the largest increase seen in community hospitals. Being older, African American, diagnosed with localized disease and treated in a community hospital rather than in an academic institution was correlated with a lower likelihood of receiving treatment in accordance with the guidelines. Efforts should be made to continuously increase the adherence rates to the MTC ATA guidelines and to decrease socioeconomic disparities that continue to exist in the treatment of MTC.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, 981225 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-1225, USA. Estelle.chang@unmc.edu.
authors.forename: Eun Hae Estelle
authors.initials: EHE
authors.lastname: Chang
authors.affiliation: Division of Otolaryngology, NorthShore University HealthSystem, Evanston, IL, USA.|Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Waseem
authors.initials: W
authors.lastname: Lutfi
authors.affiliation: General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Dr. 10th Floor, Chicago, IL, 60611, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Feinglass
authors.affiliation: Division of Endocrinology, Department of Medicine, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60021, USA.
authors.forename: Alexandra Eudokia
authors.initials: AE
authors.lastname: Reiher
authors.affiliation: Department of Surgery, NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL, 60021, USA.
authors.forename: Tricia
authors.initials: T
authors.lastname: Moo-Young
authors.affiliation: Division of Otolaryngology, NorthShore University HealthSystem, Evanston, IL, USA.|Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Mihir Kiran
authors.initials: MK
authors.lastname: Bhayani
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D018278:Carcinoma, Neuroendocrine / Q000473:pathology* / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011204:Poverty Areas; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy; D014481:United States