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Primary Care Provider Involvement in Thyroid Cancer Survivorship Care.

Radhakrishnan A, Reyes-Gastelum D, Gay B, Hawley ST, Hamilton AS, Ward KC, Wallner LP, Haymart MR. Primary Care Provider Involvement in Thyroid Cancer Survivorship Care. The Journal of clinical endocrinology and metabolism. 2020 Sep 1; 105(9).

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Abstract:

CONTEXT: While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship. OBJECTIVE: To understand PCP involvement and confidence in thyroid cancer survivorship care. DESIGN/SETTING/PARTICIPANTS: We surveyed PCPs identified by thyroid cancer patients from the Georgia and LA SEER registries (n = 162, response rate 56%). PCPs reported their involvement in long-term surveillance and confidence in handling survivorship care (role of random thyroglobulin levels and neck ultrasound, and when to end long-term surveillance and refer back to the specialist). We examined: 1) PCP-reported factors associated with involvement using multivariable analyses; and 2) bivariate associations between involvement and confidence in handling survivorship care. MAIN OUTCOME MEASURES: PCP involvement (involved vs not involved) and confidence (high vs low). RESULTS: Many PCPs (76%) reported being involved in long-term surveillance. Involvement was greater among PCPs who noted clinical guidelines as the most influential source in guiding treatment (OR 4.29; 95% CI, 1.56-11.82). PCPs reporting high confidence in handling survivorship varied by aspects of care: refer patient to specialist (39%), role of neck ultrasound (36%) and random thyroglobulin levels (27%), and end long-term surveillance (14%). PCPs reporting involvement were more likely to report high confidence in discussing the role of random thyroglobulin levels (33.3% vs 7.9% not involved; P < 0.01). CONCLUSIONS: While PCPs reported being involved in long-term surveillance, gaps remain in their confidence in handling survivorship care. Thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.





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