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Seeking patient feedback to inform changes in thyroid cancer services: A Butterfly Thyroid Cancer Trust initiative
ABSTRACTS Presentation 3. Seeking patient feedback to inform changes in thyroid cancer services: A Butterfly Thyroid Cancer Trust initiative Kate Farnell1, Abigail Walker2, Laura Moss3, Zaid Awad2 1 Butterfly Thyroid Cancer Trust, UK 2 Imperial College Healthcare NHS Trust, London, UK 3 Velindre Cancer Centre, Cardiff, UK Background/aims: The National Cancer Strategy promises to “deliver services which patients and the public want”. Thyroid cancer patients may require many decades of service provision by treatment or surveillance. The Butterfly Cancer Trust set out to study patient opinion of what they want, value, and need from these services. Methods: An anonymous survey of thyroid cancer patients was conducted. A 5-point Likert scale was used, with 19 items in 7 domains: surgeon background, outpatient clinic (OPC) setting, clinical nurse specialist (CNS), travel for treatment, post-operative management, and overall satisfaction. Results: During the 24-month survey period, 322 patients completed the questionnaire. Reliability for positively correlated items, using Cronbach’s alpha, was acceptable (>0.7). 63% felt that surgeon speciality is not important. 96% wanted an endocrinologist in outpatient clinic (OPC), and 93% preferred a combined, multi-specialty OPC. 93% wanted a thyroid CNS at diagnosis, and the same proportion wanted ongoing CNS contact following treatment. 65% would be unhappy to be seen in a general OPC, and 48% unhappy sharing OPC with head and neck cancer patients. 62% would be happy to be seen in a mixed benign/cancer thyroid clinic. 88% were happy to travel for the best care, with 26% happy to travel anywhere in the UK. 81% would travel for radioiodine, 82% for thyrogen, and 50% for radiotherapy. 84% disagreed to GP led annual surveillance blood tests or changes to thyroxine. 85% wanted a personal “thyroxine management” card or for a CNS to liaise directly with primary care. 79% were happy with the overall level of care they received. Conclusion: These findings show patients have strong opinions regarding their care which should be used to inform changes to thyroid cancer services. Patients particularly have a strong preference for, and are willing to travel to, multidisciplinary, multiprofessional, hospital based care. http://dx.doi.org/10.1016/j.ejso.2014.07.014
Presentation 4. Clinical management and outcome of metastatic follicular thyroid cancer: Single centre experience Jesse Hu Shulin, Tan Wee Boon, Ngiam Kee Yuan, Rajeev Parameswaran Department of Endocrine Surgery, National University Hospital, Singapore Background: Follicular thyroid cancer if treated early has a good prognosis. In this study we looked at the clinical outcomes of patients diagnosed with metastatic disease and relation to survival. Methods: Retrospective cohort study of patients diagnosed with follicular thyroid cancer (n¼90) referred from 2000 to 2013 to a tertiary referral centre. Demographic, laboratory and pathological data was reviewed and case notes were reviewed for survival and morbidity outcomes. Results: In the study period 19 (21%) patients were diagnosed with metastatic follicular thyroid cancer. The median age of the cohort was 65 (range 28-86) with 14 (74%) women affected. In 11 (58%) patients metastatic disease was the mode of presentation. Metastasis were to the following sites: spine (53%), lungs (37%), brain (5%) kidney (5%). 14 (78%) patients had lobectomy or total thyroidectomy for the primary disease, of whom 3 (16%) had nodal dissection as well. Four patients with advanced disease had no surgical intervention. Histology showed widely invasive follicular cancer in 16 (89%), poorly differentiated cancer in 1(5%) and minimally invasive follicular cancer in 1 (5%). In 8 (50%) patients’ metastasis developed within a median of 3 years (range 1-12). Adjuvant treatment offered were RAI (68%), radiotherapy
S5 (58%) and chemotherapy (11%). With a median follow up of 7.5 years (range 1-14), the cohort mortality is 44%. Of the 9 patients who presented with metastatic disease, the mortality is 55%, compared to 50% in those who presented with delayed metastatic disease. This is in contrast to 3% mortality in patients with non-metastatic follicular thyroid cancer. Conclusion: The clinical outcome and prognosis of patients with metastatic disease is poor compared to those with no metastatic disease. Despite this nearly half of the patients continue to be alive even in the presence of metastatic disease with aggressive clinical management. http://dx.doi.org/10.1016/j.ejso.2014.07.015
Presentation 5. A single centre experience of adrenalectomy for adrenal metastases Abigail Mawhinney, Ms Fiona Eatock Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK Background: The Adrenal glands are a common site for metastases from various malignancies. 95% of patients present with incidentalomas during imaging surveillance for their primary malignancy and may be synchronous (noted at the time of diagnosis or within 6 months of diagnosis of primary malignancy) or metachronous (more than 6 months following diagnosis). Numerous reports exist of improved survival following resection of adrenal metastases. This report aims to analyse outcomes following surgery of patients undergoing adrenalectomy for adrenal metastases in a single institution. Methods: All patients with histologically proven adrenal metastases following adrenalectomy were included. The primary malignancy, time to diagnosis (metachronous or synchronous lesions), type of resection and outcomes including; survival, development of recurrence or further metastases were recorded. Patients were excluded if benign disease was identified following resection. Results: From November 2010 until May 2014, 9 patients underwent adrenalectomy for adrenal metastases. The commonest primary malignancy was renal cell carcinoma with 4 resections. 3 patients had lung primaries, one colorectal and one oesophageal malignancy. Six presented with metachronous lesions ranging from 9 months to 5 years from initial diagnosis. 6 patients have subsequently died from their cancer. The longest disease free interval following adrenalectomy was 2 years in a patient with lung carcinoma and metachronous adrenal metastasis. The earliest tumour recurrence was within one month of resection with development of bone metastases not identified on preoperative imaging. Two further patients developed tumour recurrence within 3 months. Conclusion: Adrenalectomy for adrenal metastases is well documented within the literature. However, experience from a single unit shows that whilst some patients benefit from adrenalectomy, others have limited disease free intervals. Patient selection, MDT discussion and adequate preoperative imaging are vitally important in the decision making process. Further research in this area may highlight those with limited benefit from resection. http://dx.doi.org/10.1016/j.ejso.2014.07.016
Presentation 6. Effectiveness of preventative and other surgical measures on hypocalcaemia following bilateral thyroid surgery: A systematic review and meta-analysis R. Antakia1, O. Edafe1, L. Uttley2, S.P. Balasubramanian1 1 Department of Oncology, University of Sheffield, UK 2 The School of Health and Related Research, University of Sheffield, UK Background: Hypocalcaemia following bilateral thyroid surgery is common and is associated with significant short and long term morbidity. The aim of this study was to perform a systematic review and meta-analysis of preventive and other surgical measures on post-thyroidectomy hypocalcaemia as reported in the literature.
Presentation 4. Clinical management and outcome of metastatic follicular thyroid cancer: Single centre experience Jesse Hu Shulin, Tan Wee Boon, Ngiam Kee Yuan, Rajeev Parameswaran Department of Endocrine Surgery, National University Hospital, Singapore Background: Follicular thyroid cancer if treated early has a good prognosis. In this study we looked at the clinical outcomes of patients diagnosed with metastatic disease and relation to survival. Methods: Retrospective cohort study of patients diagnosed with follicular thyroid cancer (n¼90) referred from 2000 to 2013 to a tertiary referral centre. Demographic, laboratory and pathological data was reviewed and case notes were reviewed for survival and morbidity outcomes. Results: In the study period 19 (21%) patients were diagnosed with metastatic follicular thyroid cancer. The median age of the cohort was 65 (range 28-86) with 14 (74%) women affected. In 11 (58%) patients metastatic disease was the mode of presentation. Metastasis were to the following sites: spine (53%), lungs (37%), brain (5%) kidney (5%). 14 (78%) patients had lobectomy or total thyroidectomy for the primary disease, of whom 3 (16%) had nodal dissection as well. Four patients with advanced disease had no surgical intervention. Histology showed widely invasive follicular cancer in 16 (89%), poorly differentiated cancer in 1(5%) and minimally invasive follicular cancer in 1 (5%). In 8 (50%) patients’ metastasis developed within a median of 3 years (range 1-12). Adjuvant treatment offered were RAI (68%), radiotherapy
S5 (58%) and chemotherapy (11%). With a median follow up of 7.5 years (range 1-14), the cohort mortality is 44%. Of the 9 patients who presented with metastatic disease, the mortality is 55%, compared to 50% in those who presented with delayed metastatic disease. This is in contrast to 3% mortality in patients with non-metastatic follicular thyroid cancer. Conclusion: The clinical outcome and prognosis of patients with metastatic disease is poor compared to those with no metastatic disease. Despite this nearly half of the patients continue to be alive even in the presence of metastatic disease with aggressive clinical management. http://dx.doi.org/10.1016/j.ejso.2014.07.015
Presentation 5. A single centre experience of adrenalectomy for adrenal metastases Abigail Mawhinney, Ms Fiona Eatock Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK Background: The Adrenal glands are a common site for metastases from various malignancies. 95% of patients present with incidentalomas during imaging surveillance for their primary malignancy and may be synchronous (noted at the time of diagnosis or within 6 months of diagnosis of primary malignancy) or metachronous (more than 6 months following diagnosis). Numerous reports exist of improved survival following resection of adrenal metastases. This report aims to analyse outcomes following surgery of patients undergoing adrenalectomy for adrenal metastases in a single institution. Methods: All patients with histologically proven adrenal metastases following adrenalectomy were included. The primary malignancy, time to diagnosis (metachronous or synchronous lesions), type of resection and outcomes including; survival, development of recurrence or further metastases were recorded. Patients were excluded if benign disease was identified following resection. Results: From November 2010 until May 2014, 9 patients underwent adrenalectomy for adrenal metastases. The commonest primary malignancy was renal cell carcinoma with 4 resections. 3 patients had lung primaries, one colorectal and one oesophageal malignancy. Six presented with metachronous lesions ranging from 9 months to 5 years from initial diagnosis. 6 patients have subsequently died from their cancer. The longest disease free interval following adrenalectomy was 2 years in a patient with lung carcinoma and metachronous adrenal metastasis. The earliest tumour recurrence was within one month of resection with development of bone metastases not identified on preoperative imaging. Two further patients developed tumour recurrence within 3 months. Conclusion: Adrenalectomy for adrenal metastases is well documented within the literature. However, experience from a single unit shows that whilst some patients benefit from adrenalectomy, others have limited disease free intervals. Patient selection, MDT discussion and adequate preoperative imaging are vitally important in the decision making process. Further research in this area may highlight those with limited benefit from resection. http://dx.doi.org/10.1016/j.ejso.2014.07.016
Presentation 6. Effectiveness of preventative and other surgical measures on hypocalcaemia following bilateral thyroid surgery: A systematic review and meta-analysis R. Antakia1, O. Edafe1, L. Uttley2, S.P. Balasubramanian1 1 Department of Oncology, University of Sheffield, UK 2 The School of Health and Related Research, University of Sheffield, UK Background: Hypocalcaemia following bilateral thyroid surgery is common and is associated with significant short and long term morbidity. The aim of this study was to perform a systematic review and meta-analysis of preventive and other surgical measures on post-thyroidectomy hypocalcaemia as reported in the literature.