An audit of management of differentiated thyroid cancer in specialist and non-specialist clinic settings

OBJECTIVE Thyroid cancer is the most common endocrine malignancy but is non e the less rare. Some aspects of its management remain controversial. Previ ous audits of patient management in the United Kingdom have revealed defici encies, especially in communication between specialists. We have audited pa tient management in a large university-associated teaching hospital, assess ing points of good practice identified from published guidelines and review s, and have compared findings in groups of patients managed jointly by spec ialists with an interest in thyroid cancer (including surgeon, endocrinolog ist and oncologist) with a group managed by other clinicians outside that s etting. DESIGN AND PATIENTS Retrospective case-note review of 205 patients with dif ferentiated (papillary or follicular) cancer including group A (n = 134; ma naged in a specialist multi-disciplinary clinic setting) and group B (n = 7 1; managed in other clinic settings). Points of good practice investigated were adequacy of surgery, surgical complications, prescription and adequacy of 14 treatment, adequacy of monitoring by measurement of serum thyroglobu lin and action taken and appropriate administration of ablative radioiodine . RESULTS Deficiencies in management of the cohort as a whole were identified , including inadequate surgery and inadequate TSH suppression in approximat ely one-fifth of the cases. Monitoring with thyroglobulin measurements and action when serum thyroglobulin was high were also inadequate in some cases and ablative radioiodine was not given, despite being indicated in 11.7% o f the cohort. Inadequate surgery and failure to administer radioiodine were less common in those managed in a specialist clinic setting than in those managed in other clinic settings. CONCLUSIONS The findings highlight the need for locally agreed protocols in managing relatively rare endocrine disorders such as thyroid cancer and ar gue in favour of centralization of expertise and patient management in mult i-disciplinary specialist clinic settings.