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Hospital characteristics account for variations in radioactive iodine use for thyroid cancer

Haymart MR. JAMA. 2011;306:721-728.

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Between 1990 and 2008, hospital characteristics affected the proportion of patients with thyroid cancer who received radioactive iodine. According to researchers, tumor and patient characteristics accounted for only 21.1% of the variation in radioactive iodine use during this time period.

“What hospital you go to makes a difference in use of radioactive iodine,” Megan R. Haymart, MD, assistant professor of internal medicine at the University of Michigan Medical Center, said in a press release. “It doesn’t matter what the tumor looks like, but where you go for care.”

Haymart and colleagues analyzed data collected from the National Cancer Database for 189,219 patients diagnosed with well-differentiated thyroid cancer between 1990 and 2008 who were treated at 981 hospitals across the United States. They aimed to determine patterns in radioactive iodine use, variations among hospitals and the factors associated with such variation.

Their analysis demonstrated that the use of radioactive iodine increased significantly overall, across all tumor sizes during the time period studied, from 40.4% in 1990 to 56% in 2008 (P<.001). According to multivariate analysis, treatment with radioactive iodine varied significantly by cancer stages I and IV among patients treated between 2004 and 2008 (OR=0.34; 95% CI, 0.31-0.37). However, there was no statistical variation among stages II/III and IV (stage II vs. stage IV, OR=0.97; 95% CI, 0.88-1.97 and stage III vs. stage IV, OR=1.06; 95% CI, 0.95-1.17). Despite these variations due to patient and tumor characteristics, they only accounted for 21.1% of variation in radioactive iodine use.

Hospital characteristics also contributed to variations in radioactive iodine use: hospital type and case volume explained 17.1% of the variation and unexplained hospital characteristics accounted for 29.1% of the variation, after adjusting for patient, tumor and hospital characteristics.

“Even among people who are high-risk — and the guidelines are clear that these patients should receive radioactive iodine — there is still variation,” Haymart said. “This suggests doctors are unclear about the indications for radioactive iodine. We need randomized clinical trials that look at radioactive iodine in low-risk patients so that we can set better guidelines for its use.”

Disclosure: Dr. Haymart reports no relevant financial disclosures.

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