低危甲状腺癌患者从专科向初级保健过渡的结果。
Outcomes of Early Transition of Low-Risk Thyroid Cancer Patients from Specialist to Primary Care.
机构信息
Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada.
University of Toronto, Toronto, ON M5S 1A1, Canada.
出版信息
Curr Oncol. 2022 Oct 14;29(10):7672-7679. doi: 10.3390/curroncol29100606.
BACKGROUND
Recently published clinical pathways for management of thyroid cancer outlined the criteria for transitioning low-risk patients to primary care within one to five years from diagnosis. However, discharge patterns among endocrinologists remain heterogeneous as there lacks a consensus regarding post-treatment care for thyroid cancer patients.
OBJECTIVE
This study described general characteristics and outcomes of thyroid cancer patients who were discharged from specialist care and transitioned to a primary care-based follow-up clinic.
METHODS
Thyroid cancer patients seen in the After Cancer Treatment Transition (ACTT) clinic at Women's College Hospital (Toronto, Canada) were included in the study. Electronic medical records were reviewed between May and October 2021 to collect patient characteristics and outcomes. Descriptive statistics were calculated.
RESULTS
The study cohort included 148 thyroid cancer patients and 76% were female. All cases were papillary thyroid cancer and most diagnoses were classified as T (42%), N (55%), M (91%), and stage 1 (83%). Nearly all patients ( = 147) had complete thyroidectomy. Levels of thyroglobulin and thyroglobulin antibodies (TgAb) were low overall, with only 5% of the study cohort deemed TgAb positive. Mean levels of thyroid stimulating hormone (TSH) measured at 2 time points (1.37 mIU/L, 1.42 mIU/L) were within normal range. About 91% of the study cohort had normal TSH levels and 82% met target TSH levels. There were 2 cases of recurrence; however, investigation determined that they were not initially appropriate candidates for transition to primary care. Nearly 99% ( = 146) of patients had excellent response to therapy, showed no evidence of disease recurrence, and have not required re-referral to specialist care.
CONCLUSIONS
These findings may reassure specialists that low-risk, stable thyroid cancer patients can be safely transitioned to primary care for post-treatment follow-up.
背景
最近发布的甲状腺癌临床路径概述了低危患者从诊断后一至五年内转至初级保健的标准。然而，内分泌学家的出院模式仍然存在差异，因为缺乏关于甲状腺癌患者治疗后护理的共识。
目的
本研究描述了从专科治疗出院并转至基于初级保健的随访诊所的甲状腺癌患者的一般特征和结局。
方法
本研究纳入了在加拿大多伦多女子学院医院的癌症治疗后过渡（ACTT）诊所就诊的甲状腺癌患者。在 2021 年 5 月至 10 月期间，对电子病历进行了回顾，以收集患者特征和结局。计算了描述性统计数据。
结果
研究队列包括 148 例甲状腺癌患者，其中 76%为女性。所有病例均为甲状腺乳头状癌，大多数诊断为 T（42%）、N（55%）、M（91%）和 1 期（83%）。几乎所有患者（=147）均行全甲状腺切除术。总体而言，甲状腺球蛋白和甲状腺球蛋白抗体（TgAb）水平较低，只有 5%的研究队列被认为 TgAb 阳性。在 2 个时间点测量的促甲状腺激素（TSH）的平均水平（1.37 mIU/L，1.42 mIU/L）在正常范围内。研究队列中约 91%的患者 TSH 水平正常，82%的患者达到 TSH 目标水平。有 2 例复发病例；然而，调查确定他们最初不是转至初级保健的合适人选。近 99%（=146）的患者对治疗有极好的反应，无疾病复发迹象，且无需再次转至专科治疗。
结论
这些发现可能使专家放心，低危、稳定的甲状腺癌患者可以安全地转至初级保健进行治疗后随访。
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