Over the past several decades, the incidence of thyroid cancer in the United States has increased substantially surmounting to higher levels of concern for physicians around the nation. This concern led to a research investigation surrounding the increased risk thyroid cancer patients may face by delaying their surgeries.
OBJECTIVE: We aim to evaluate the impact of a delay in surgical intervention on survival in patients with a diagnosis of papillary thyroid cancer.
METHODS: This is an observational retrospective study focusing on disease specific survival using SEER-Medicare data as well as data from the National Cancer Database to analyze whether a delay in surgical intervention leads to a decrease in mortality in patients with papillary thyroid cancer. This study focuses on specific thyroid cancer association beyond that of another research paper that found delaying time to surgery does decrease overall survival as discovered by Dr. Scott Fligor in 2021. For the purposes of this study, data was accessed between the years 1999-2018. A survival analysis was performed using the Cox-
hazard ratio as well as Kaplan-Meier curves.
RESULTS: Preliminary results detail the fact that delaying surgeries past 180 days for patients led to decreased survival over a course of 5, 10, and 15 years as was determined by the use of Kaplan Meyer curves and the Cox hazard ratio. A positive coefficient for a Cox hazard ratio indicates a worse prognosis whereas a negative coefficient indicates the opposite. The results of this study show that increasing time to surgery increases risk of mortality for patients as the hazard ratios suggest for this research. The hazard ratio for 90 – 180 days delay for patients versus patients who underwent surgery within 0 – 90 days was 1.18 (95% confidence internal, 0.96 – 1.45). This hazard ratio is lower than that of the group that underwent surgery after 180+ days whose hazard ratio was 1.21 (95% confidence internal, 0.89 – 1.66). Since the hazard ratio for patients who delayed surgery after 180+ days is higher than the 0 – 90 days as well as the 90 – 180 days, this indicates a worse prognosis over time for patients with increased delays.
CONCLUSION: Delaying surgery for thyroid cancer patients deceases their overall survival over a period of 5, 10, and 15 years. Elective or lower risk surgeries over the past 3 years have been delayed due to the Covid-19 pandemic, and thus this data was excluded for the purposes of this study. Further research should be done on the effects the pandemic had on the overall survival for patients who had to delay their surgeries due to the pandemic.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46316 |
| Date | 09 June 2023 |
| Creators | Rosner, Jessica |
| Contributors | Levy, Simon |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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