ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM

Grace C. Haser, R. Michael Tuttle, Henry K. Su, Eran E. Alon, Donald Bergman, Victor Bernet, Elise Brett, Rhoda Cobin, Eliza H. Dewey, Gerard Doherty, Laura L. Dos Reis, Jeffrey Harris, Joshua Klopper, Stephanie L. Lee, Robert A. Levine, Stephen J. Lepore, Ilya Likhterov, Mark A. Lupo, Josef Machac, Jeffrey I. MechanickSaral Mehra, Kresimira Milas, Lisa A. Orloff, Gregory Randolph, Tracey A. Revenson, Katherine J. Roberts, Douglas S. Ross, Meghan E. Rowe, Robert C. Smallridge, David Terris, Ralph P. Tufano, Mark L. Urken

    Research output: Contribution to journalReview article

    25 Citations (Scopus)

    Abstract

    OBJECTIVE: The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy.

    METHODS: We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed.

    RESULTS: Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance.

    CONCLUSION: With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

    Original languageEnglish (US)
    Pages (from-to)602-611
    Number of pages10
    JournalEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
    Volume22
    Issue number5
    DOIs
    StatePublished - May 1 2016

    Fingerprint

    Delivery of Health Care
    Thyroid Gland
    Quality of Life
    Psychology
    Papillary Thyroid Microcarcinoma
    Traction
    Patient Education
    Early Detection of Cancer
    Thyroid Neoplasms
    Patient Selection
    Organizations
    Physicians
    Population

    ASJC Scopus subject areas

    • Endocrinology, Diabetes and Metabolism
    • Endocrinology

    Cite this

    ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA : NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM. / Haser, Grace C.; Tuttle, R. Michael; Su, Henry K.; Alon, Eran E.; Bergman, Donald; Bernet, Victor; Brett, Elise; Cobin, Rhoda; Dewey, Eliza H.; Doherty, Gerard; Dos Reis, Laura L.; Harris, Jeffrey; Klopper, Joshua; Lee, Stephanie L.; Levine, Robert A.; Lepore, Stephen J.; Likhterov, Ilya; Lupo, Mark A.; Machac, Josef; Mechanick, Jeffrey I.; Mehra, Saral; Milas, Kresimira; Orloff, Lisa A.; Randolph, Gregory; Revenson, Tracey A.; Roberts, Katherine J.; Ross, Douglas S.; Rowe, Meghan E.; Smallridge, Robert C.; Terris, David; Tufano, Ralph P.; Urken, Mark L.

    In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, Vol. 22, No. 5, 01.05.2016, p. 602-611.

    Research output: Contribution to journalReview article

    Haser, GC, Tuttle, RM, Su, HK, Alon, EE, Bergman, D, Bernet, V, Brett, E, Cobin, R, Dewey, EH, Doherty, G, Dos Reis, LL, Harris, J, Klopper, J, Lee, SL, Levine, RA, Lepore, SJ, Likhterov, I, Lupo, MA, Machac, J, Mechanick, JI, Mehra, S, Milas, K, Orloff, LA, Randolph, G, Revenson, TA, Roberts, KJ, Ross, DS, Rowe, ME, Smallridge, RC, Terris, D, Tufano, RP & Urken, ML 2016, 'ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM', Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 22, no. 5, pp. 602-611. https://doi.org/10.4158/EP151065.RA
    Haser, Grace C. ; Tuttle, R. Michael ; Su, Henry K. ; Alon, Eran E. ; Bergman, Donald ; Bernet, Victor ; Brett, Elise ; Cobin, Rhoda ; Dewey, Eliza H. ; Doherty, Gerard ; Dos Reis, Laura L. ; Harris, Jeffrey ; Klopper, Joshua ; Lee, Stephanie L. ; Levine, Robert A. ; Lepore, Stephen J. ; Likhterov, Ilya ; Lupo, Mark A. ; Machac, Josef ; Mechanick, Jeffrey I. ; Mehra, Saral ; Milas, Kresimira ; Orloff, Lisa A. ; Randolph, Gregory ; Revenson, Tracey A. ; Roberts, Katherine J. ; Ross, Douglas S. ; Rowe, Meghan E. ; Smallridge, Robert C. ; Terris, David ; Tufano, Ralph P. ; Urken, Mark L. / ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA : NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM. In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2016 ; Vol. 22, No. 5. pp. 602-611.
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    abstract = "OBJECTIVE: The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy.METHODS: We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed.RESULTS: Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance.CONCLUSION: With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.",
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    T2 - NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM

    AU - Haser, Grace C.

    AU - Tuttle, R. Michael

    AU - Su, Henry K.

    AU - Alon, Eran E.

    AU - Bergman, Donald

    AU - Bernet, Victor

    AU - Brett, Elise

    AU - Cobin, Rhoda

    AU - Dewey, Eliza H.

    AU - Doherty, Gerard

    AU - Dos Reis, Laura L.

    AU - Harris, Jeffrey

    AU - Klopper, Joshua

    AU - Lee, Stephanie L.

    AU - Levine, Robert A.

    AU - Lepore, Stephen J.

    AU - Likhterov, Ilya

    AU - Lupo, Mark A.

    AU - Machac, Josef

    AU - Mechanick, Jeffrey I.

    AU - Mehra, Saral

    AU - Milas, Kresimira

    AU - Orloff, Lisa A.

    AU - Randolph, Gregory

    AU - Revenson, Tracey A.

    AU - Roberts, Katherine J.

    AU - Ross, Douglas S.

    AU - Rowe, Meghan E.

    AU - Smallridge, Robert C.

    AU - Terris, David

    AU - Tufano, Ralph P.

    AU - Urken, Mark L.

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    N2 - OBJECTIVE: The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy.METHODS: We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed.RESULTS: Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance.CONCLUSION: With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

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