The incidence of differentiated thyroid cancer (DTC) is rising, but controversy exists in many aspects of its treatment. This study described the change in incidence of DTC in Ontario, variations in management including extent of thyroidectomy and the influence of provider volume, and the impact of these parameters on recurrence and thyroid cancer-specific death (TCSD). A population-based study identified all new cases of DTC between 1992-2007. The incidence of DTC increased dramatically (annual percentage change 7.6%). Linkage to administrative databases revealed that extent of thyroidectomy is influenced by various factors including patient gender, age, year of diagnosis, surgeon specialty, and hospital setting, but not provider volume. Total thyroidectomy is associated with a lower recurrence rate. There is a significant association between provider volume and recurrence, with lower volume surgeons having a higher recurrence risk. Extent of thyroidectomy and provider volume did not influence TCSD. Such variations in management may lead to disparities in health outcomes.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/35143 |
| Date | 19 March 2013 |
| Creators | Tasevski, Robert |
| Contributors | Urbach, David Robert |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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