My Treatment Approach: Applying Evidence to Clinical Practice to Improve Outcomes in Differentiated Thyroid Cancer - Episode 4
A brief discussion on where endocrinologists and oncologists respectively fit into the differentiated thyroid cancer treatment paradigm.
Marcia Brose, MD: Let me just ask a quick question, Bruce. Could you just tell us about—and I know you're obviously in Australia and you're not here in the states—when do patients usually see an endocrinologist or an oncologist? How does that work? And then, Lori, maybe you can tell us about how you see it happening here?
Bruce Robinson, MD: Well, it varies a little bit from state to state in Australia as to who looks after patients with thyroid cancer. I suppose most of such patients are looked after by endocrinologists. But increasingly some of those endocrinologists are reluctant to use TKIs [tyrosine kinase inhibitors], and we've had a strong educational program to try to give them the confidence and experience, and even partnering with them as they do gain that experience. We see nuclear medicine physicians sometimes looking after these patients, endocrinologists looking after them, and increasingly we're starting to see oncologists look after them as well. Although my concern about that is that tends to cause discontinuation of patient care because they start off with an endocrinologist or a nuclear medicine physician and then end up with an oncologist, and I think overall that's not necessarily the best thing for the patients.
Marcia Brose, MD: But how does it work for you, Lori?
Lori Wirth, MD: It is an institutional-based thing; different programs have different people involved. Here in Boston, we've got a number of thyroid cancer endocrinology specialists who are quite comfortable taking care of patients who have metastatic iodine-refractory disease, when it's low volume disease that's growing slowly and where TKI therapy may not be indicated right away. But they tend to refer patients to our medical oncology group nonetheless rather early on so that we can get to know the patient so that there is some continuity of care. They don't just send them to me and then I start a TKI at the next visit. And it's also helpful because we are now doing genotyping prior to initiating systemic therapy, and that is something that that we do in medical oncology a lot more. And it's such a rapidly changing field that it is useful when the genotyping aspect of the process is handled in medical oncology in general because of how rapidly changing the field is with the different tests that are emerging. We used to always use our own in-house assay, which is very robust, but now there's a commercial assay that has a couple of extra bells and whistles that we're using more frequently. And we just tend to stay on top of that.
Marcia Brose, MD: Which one is that, Lori?
Lori Wirth, MD: That's the Caris assay that also provides us with tumor mutational burden and HLA typing, et cetera.
Marcia Brose, MD: That's interesting that you say that because that what we're using too.
Transcript edited for clarity.