RESUMO
BACKGROUND: Healthcare disparities associated with insurance and socioeconomic status have been well characterized for several malignancies, such as lung cancer. To assess whether there are healthcare disparities in thyroid cancer, this study evaluated the stage on initial presentation of patients with differentiated thyroid cancer (DTC) in a public versus university teaching hospital. METHODS: A retrospective chart review was performed to identify patients with a new diagnosis of DTC from January 1, 2007, to January 1, 2010, in a large public and adjoining university teaching hospital at a single academic medical center. Medical records were reviewed for demographics, pathology, and American Joint Committee on Cancer tumor-node-metastasis stage at initial presentation. RESULTS: There were 49 cases of well-DTC (96% papillary and 4% Hürthle) in the public hospital and 370 cases (95% papillary, 2% Hürthle, and 3% follicular) in the university teaching hospital. Median age (years) at presentation was 50 in the public versus 48 in the university teaching hospital (p=0.39). Ninety-six percent of public hospital patients were from ethnic minorities compared with 16% of university teaching hospital patients (p<0.0001). Only 1 (2%) public hospital patient had private insurance compared with 85% of university teaching hospital patients. Tumor status (p=0.002) and stage (p=0.03) were more advanced and extrathyroidal extension (p=0.02) was more prevalent among public hospital patients compared with university teaching hospital patients. In a multivariable analysis, public hospital, male gender, increasing age, advanced tumor status, and the presence of lymphovascular invasion were the best predictors of more advanced disease stage. Public hospital patients were 3.4 times more likely to present with advanced DTC than university teaching hospital patients of the same age, gender, tumor status, and lymphovascular invasion status (95% confidence interval 1.29-8.95). CONCLUSIONS: In a public hospital, where the patient population is defined primarily by insurance status, patients were more likely to present with advanced-stage DTC than patients presenting to an adjacent university teaching hospital. These results suggest a disparity in the stage on initial presentation of DTC, possibly resulting in a delayed diagnosis of cancer.
Assuntos
Disparidades em Assistência à Saúde , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/patologia , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma , Carcinoma Papilar , Criança , Demografia , Feminino , Humanos , Cobertura do Seguro , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cidade de Nova Iorque , Estudos Retrospectivos , Câncer Papilífero da TireoideRESUMO
The advancement of laparoscopic adrenalectomy over the past decade has completely changed the surgical approach to adrenal tumors. As the incidence of incidentally discovered adrenal tumors increases, most patients with resectable lesions can undergo resection laparoscopically with minimal morbidity, shorter hospitalization, and low mortality. The spectrum of surgical approaches now available make it possible to provide an appropriate resection that is matched to the specific characteristics of each tumor. Experienced surgeons now resect some malignant tumors laparoscopically, with the option to convert to a hand-assisted or traditional open approach.