Abstract
Today's delivery of care to thyroid cancer patients is complex, and costly, with uneven outcomes that can be improved. The incidence of thyroid cancer is rising and requires coordinated, multidisciplinary care with high volume centers that is not always available in our current fragmented healthcare system. To address the needs of patients, providers and payers, we believe that thyroid cancer care needs to be reexamined from the perspective of value for the patient, which is defined as the outcomes that matter to patients relative to the cost of delivering them. This paper provides recommendations based on the key principles of the value-based approach to transform the delivery of thyroid cancer care.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1 . Redefining Healthcare: Creating Value-Based Competition on Results. Harvard Business School Press, Boston, MA, USA (2006). •• The definitive textbook that began the value-based healthcare movement in the USA.
- 2 . The strategy that will fix healthcare. Hav. Bus. Rev. 91(10), 50–70 (2013). • A concise review of the six essential aspects of creating a value-based healthcare program.
- 3 . What is value in healthcare? N. Engl. J. Med. 363(26), 2477–2481 (2010).
- 4 . How to solve the cost crisis in healthcare. Hav. Bus. Rev. 89(9), 47–64 (2011). •• Reviews a new approach to controlling spiraling healthcare costs – accurate measurement.
- 5 Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing. Healthcare 1(3–4), 136–142 (2013). • Describes how accurate costing can be used to shape and assess performance improvement.
- 6 . Orthochoice: bundled payments in the county of Stockholm (a). Harvard Business School Supplement. (Case 714–514), (2015).
- 7 SEER stat fact sheets: Thyroid cancer (2015). www.seer.cancer.gov/statfacts/html/thyro.html.
- 8 . Thyroid carcinoma. Lancet 361(9356), 501–511 (2003).
- 9 . Current thyroid cancer trends in the United States. JAMA Otolaryngol. Head Neck Surg. 140(4), 317–322 (2014).
- 10 The clinical and economic burden of a sustained increase in thyroid cancer incidence. Cancer Epideomiol Biomakers Prev. 22(7), 1252–1259 (2013).
- 11 Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health affairs. 32(6), 1143–1152 (2013).
- 12 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2015). • The most updated US guidelines on the management of differentiated thyroid cancer.
- 13 Thyroid carcinoma, version 2.2014. J. Natl Compr. Canc. Netw. 12(12), 1671–1680; quiz 1680 (2014).
- 14 Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11), 1167–1214 (2009).
- 15 The 2009 American Thyroid Association guidelines modestly reduced radioactive iodine use for thyroid cancers less than 1 cm. Thyroid 24(10), 1549–1550 (2014).
- 16 AJCC Cancer Staging Manual (7th Edition). Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (Eds). Springer, NY, USA (2010).
- 17 American Thyroid Association Guidelines Task Force. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25(7), 716–759 (2015). • First published US guidelines on the management of differentiated thyroid cancer in the pediatric population.
- 18 The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev. 32(6), 798–826 (2011).
- 19 Thyroid cancer incidence patterns in the United States by histologic type,1992–2006. Thyroid 21(2), 125–134 (2011).
- 20 Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 25(6), 567–610 (2015). • The most updated US guidelines on the management of medullary thyroid cancer.
- 21 The clinical endocrinology workforce: Current status and future projections of supply and demand. J. Clin. Endocrinol. Metab. 99(9), 3112–3121 (2014).
- 22 Remnant uptake as a postoperative oncologic quality indicator. Thyroid 23(10), 1269–1276 (2013).
- 23 . National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope 123(8), 2056–2063 (2013).
- 24 Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142(6), 887–899 (2007).
- 25 Patients treated at low-volume centers have higher rates of incomplete resection and compromised outcomes: analysis of 31,129 patients with papillary thyroid cancer. Ann. Surg. Onco. 23(2), 403–409 (2015).
- 26 Variation in the management of thyroid cancer. J. Clin. Endocrinol. Metab. 98(5), 2001–2008 (2013).
- 27 The relationship between extent of thyroid cancer surgery and use of radioactive iodine. Ann. Surg. Oncol. 258(2), 354–358 (2013).
- 28 Surgeon training and use of radioactive iodine in stage i thyroid cancer patients. Ann. Surg. Oncol. 20(3), 733–738 (2013).
- 29 The role of clinicians in determining radioactive iodine use for low-risk thyroid cancer. Cancer 119(2), 259–265 (2013).
- 30 . Predictors of outcomes following pediatric thyroid and parathyroid surgery. Curr. Opin Oncol. 21(1), 23–28 (2009).
- 31 Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. Thyroid 25(4), 377–385 (2015).
- 32 Development and initial validation of the thyroid cancer module of the M.D. Anderson symptom inventory. Oncology 76(1), 59–68 (2009).
- 33 The efficacy of the natural clay, casad, in reducing medullary thyroid cancer-related diarrhea and its effects on quality of life: a pilot study. Thyroid 24(S1), P166 (2014).
- 34 Improving patient access to an interventional us clinic. Radiographics 34(1), e18–e23 (2014).
- 35 Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new american thyroid association staging system. Thyroid 20(12), 1341–1349 (2010).
- 36 Response to initial therapy predicts clinical outcomes in medullary thyroid cancer. Thyroid 25(2), 242–249 (2015).