Practical Barriers to Implementation of Thyroid Cancer Guidelines in the Asia-Pacific Region |
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| Institution: | 1. From the Endocrinology Division, Department of Medicine, National University Hospital, Singapore;2. Yong Loo Lin School of Medicine, National University of Singapore;3. Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York;4. Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore;5. The Endocrine Clinic, Mount Elizabeth Medical Centre, Singapore.;1. From the Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy;2. Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Parma, Italy;3. Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy;4. Azienda Sanitaria Firenze, Firenze, Italy;5. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy;6. National Institute on Aging, National Institutes of Health, Baltimore, Maryland. |
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| Abstract: | Objective: Numerous published guidelines have described the optimal management of thyroid cancer. However, these rely on the clinical availability of diagnostic and therapeutic modalities. We hypothesized that the availability of medical resources and economic circumstances vary in Asia-Pacific countries, making it difficult to implement guideline recommendations into clinical practice.Methods: We surveyed participants at the 2009 and 2013 Congresses of the Association of Southeast Asian Nations Federation of Endocrine Societies by distributing questionnaires to attendees at registration.Results: Responses were obtained from 268 respondents in 2009 and 163 respondents in 2013. Similar to the high prevalence of low-risk thyroid cancer observed in the Surveillance, Epidemiology, and End Results database, across the Asia-Pacific countries surveyed in 2009 and 2013, 50 to 100% of the respondents from the Philippines, Malaysia, Singapore, China, Taiwan, Thailand, Hong Kong, Korea, and Sri Lanka reported that more than 50% of the patients had low-risk thyroid cancer on follow-up. Importantly, there was much variation with regards to the perceived availability of investigation and treatment modalities.Conclusion: We found a wide variation in clinicians' perception of availability of diagnostic and therapeutic modalities in the face of a rise in thyroid cancer incidence and thyroid cancer management guidelines that emphasized their importance. The lack of availability of management tools and treatments will prove to be a major barrier to the implementation of thyroid cancer management guidelines in Southeast Asia, and likely in other parts of the world as well.Abbreviations: AFES = ASEAN Federation of Endocrine Societies ASEAN = Association of Southeast Asian Nations ATA = American Thyroid Association FNA = fine-needle aspiration PET = positron emission tomography RAI = radioactive iodine Tg = thyroglobulin TSH = thyroid-stimulating hormone |
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