Use of Neck Ultrasound as Surveillance in Older Adults With Thyroid Cancer.

Abstract

Objective: Close to one-quarter of thyroid cancers occur in older adults (ie, aged ≥ 65). This group also has other comorbidities and higher risk of death from other causes. Data on optimal neck ultrasound use for thyroid cancer surveillance in older adults are limited.

Methods: We identified patients aged ≥ 65 years diagnosed with thyroid cancer using data from the Centers for Medicare & Medicaid Services linked to health data from University of Michigan between 2016-2021 (median follow-up 3 years, range 0-6 years). We assessed demographic characteristics, comorbidities, frequency of neck ultrasound, and cause of death.

Results: Of the 2007 patients diagnosed with thyroid cancer, median age was 74 years (range 65-100) and 65.1% were female. Overall, 76 (3.8%) died of thyroid cancer, and 259 (12.9%) died of other causes. There were more comorbidities in the cohort who died of other causes during the study period, eg, 179 (69.1%) in the cohort who died of other causes had heart disease compared with 868 (43.3%) of those in the entire cohort. Patients who died of other causes received a mean of 1.36 neck ultrasounds (range 0-12) and the remainder of the cohort received a mean of 2.38 neck ultrasounds (range 0-26) during the study period, P < .001.

Conclusions: Older adults with thyroid cancer are more likely to die of causes other than thyroid cancer. To improve high-value care in older adults with thyroid cancer and high-risk of death from other causes, there is need for individualized plans for neck ultrasound use.