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Disclosures: The authors report no relevant financial disclosures.
April 23, 2021
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Clinical context crucial when treating thyroid cancer in older adults

Disclosures: The authors report no relevant financial disclosures.
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Providers should consider clinical context, including comorbidities, when diagnosing and managing thyroid cancer in older adults, according to a study published in Thyroid.

“As our population is aging, it is increasingly important that we balance benefits and risks,” Megan R. Haymart, MD, professor of medicine and the Nancy Wigginton Endocrinology Research Professor of Thyroid Cancer in the department of metabolism, endocrinology and diabetes at the University of Michigan, told Healio. “A one-size-fits-all model is no longer appropriate. Older adults with thyroid cancer represent a heterogeneous patient population, and incorporating competing risks of death and comorbidities into the decision-making process will help physicians pursue a balanced, individualized approach to care.”

Haymart is a professor of medicine and the Nancy Wigginton Endocrinology Research Professor of Thyroid Cancer in the department of metabolism, endocrinology and diabetes at the University of Michigan.

Haymart and colleagues conducted a retrospective cohort study using data from the Surveillance, Epidemiology and End Results (SEER)-Medicare data files. Patients diagnosed with any type of thyroid cancer at age 66 years or older between 2000 and 2015 were included. Demographics, cause of death and survival time were obtained from the SEER database. SEER data were also used to obtain information on tumor characteristics, such as histology, tumor size and SEER stage. Data on comorbidities, including heart disease, chronic lower respiratory disease, cerebrovascular disease, Alzheimer’s disease and diabetes, were identified through Medicare data.

Thyroid cancer mortality trends

There were 21,509 older adults with a history of thyroid cancer included in the analysis (median age, 72 years; 69.5% women; 79.3% white). Overall, 12.3% died of thyroid cancer during a median follow-up of 50 months, whereas 19.4% died of other causes.

For those with medullary thyroid cancer, a higher proportion died of thyroid cancer initially, but the proportion of those dying of other causes was higher after 6.25 years of follow-up. In differentiated thyroid cancer, a higher proportion died of other causes over time, whereas a higher proportion of those with anaplastic thyroid cancer died of thyroid cancer over time, with the rate of death highest 1 year after diagnosis.

Older adults with anaplastic thyroid cancer were more likely to die of cancer compared with those diagnosed with papillary thyroid cancer (HR = 5.51; 95% CI, 4.82-6.31). A tumor larger than 4 cm presented a greater risk for thyroid cancer death compared with a tumor of 1 cm or less (HR = 3.35; 95% CI, 2.71-4.15), and older adults with a distant SEER stage had an increased risk for death from thyroid cancer compared with people with a localized SEER stage (HR = 12.65; 95% CI, 10.91-14.66).

Mortality trends with demographics, comorbidities

Adults aged 85 years or older with thyroid cancer were more likely to die of other causes (HR = 4.01; 95% CI, 3.55-4.54) and thyroid cancer (HR = 1.96; 95% CI, 1.69-2.26) compared with those aged 66 to 69 years. Men had a higher risk for death from other causes compared with women (HR = 1.47; 95% CI, 1.37-1.57), and Black adults had a greater risk for noncancer-related death compared with white adults (HR = 1.3; 95% CI, 1.16-1.46). People with comorbidities such as heart disease (HR = 1.34; 95% CI, 1.25-1.44) or chronic lower respiratory disease (HR = 1.25; 95% CI, 1.17-1.34) had a higher risk for death from other causes.

“As our treatments for thyroid cancer could put patients at risk for surgical complications as well as cardiac and skeletal complications secondary to suppressive doses of thyroid hormone therapy, understanding competing causes of death can lead to more tailored treatment of thyroid cancer,” Haymart said. “For older patients with minimal comorbidities, good health and a relatively long life expectancy, more intensive management of thyroid cancer may be warranted. For older patients who are likely to die of another etiology in the near future, aggressive thyroid cancer treatment could negatively impact quality of life, but not improve overall survival. Therefore, treatment decisions should be informed by more than just the severity of the cancer.”

For more information:

Megan R. Haymart, MD, can be reached at meganhay@med.umich.edu.