The optimum approach to long-term follow-up of well differentiated thyroid cancer (DTC) remains unclear. We assessed the outcome of DTC patients followed in primary care (PrC) from Edmonton, AB with tertiary care (TrC) settings from Halifax, NS and London, ON. Patients who met the following criteria were identified: a) Initial diagnosis between January 1, 2006 to December 31, 2011, b) primary tumour
A total of 317 patients, (PrC=93 and TrC=224) were identified. Female preponderance (PrC=83% and TrC=87%), mean age at presentation (PrC=46.02 yrs. and TrC=47.7 yrs., prevalence of papillary thyroid cancer (PrC=94% and TrC=96%), mean follow-up (PrC=62.24 months and TrC=64.6 months) and mean tumour size at presentation (PrC=1.35 CM and TrC=1.26 CM) were similar (all P=NS). All patients had undergone near-total thyroidectomy. The risk of recurrence was similar (PrC=1.1% and TrC=1.3%; P=0.69). Recurrences were identified through ultrasound (US) and rising TG in TrC group and only through rising TG in PrC group. There were 3 deaths in TrC (all unrelated to DTC), and no death in the PrC group. Rate of US surveillance was similar (PrC=60% and TrC=53%) (P=0.21). There were a mean of 5.25 visits to specialist clinic in TrC group. Serum TSH was outside the target range in 14% PrC and 60% TrC patients.
Our data shows that follow-up of DTC in primary care is a feasible alternative and the outcome of patients in primary care is similar to a specialist centre. Our data support the notion of discharging low-risk DTC to primary care; however, clear guidelines must be provided to the primary care physicians at the time of discharge.