The COVID-19 outbreak and de-escalation of thyroid cancer diagnosis and treatment

Excerpt

The COVID-19 outbreak in Italy forced the healthcare system to cancel all non-urgent outpatient activities in order to avoid further spread of the disease inside hospitals and other healthcare facilities. At our institution, all thyroid nodule activities were canceled between March and May 2020, though the hospital allowed treatment and consultations for all cancer patients. For these patients, the medical team distinguished patients with immediate needs from patients whose procedures could be postponed [1]. Even after this timeframe, the capacity of the hospital to perform non-urgent thyroid surgeries was reduced [2]. All patients were reassured that these changes would not have any impact on their disease-related outcomes. Indeed, a de-escalation process of care and a risk-adapted approach to thyroid cancer management had already been underway in recent years in accordance with main international guidelines [3]. Our team had started several years ago to reduce the procedures performed, both for the diagnostic workup of thyroid nodules and for the treatment and follow-up of diagnosed thyroid cancers [4]. Namely, we had already reduced the number of unnecessary fine-needle aspiration biopsies [5], proposed more conservative surgery, suggested active surveillance for non-threatening papillary thyroid microcarcinomas [6], and used ancillary tools to avoid diagnostic surgeries for indeterminate thyroid nodules, such as sonographic risk stratification and molecular testing [7]. Furthermore, we reduced the frequency of neck sonographies in the follow-up of differentiated thyroid cancer [8] and the use of radioiodine treatment [9]. All these decisions required thorough discussion with patients, caregivers, and other physicians, and as a result the de-escalation of treatment burden was not easily accepted, partially due to the underestimation of the risks of healthcare interventions. While the COVID-19 pandemic has forced hospitals to withhold many useful services, it has also provided an opportunity to focus on the risk-benefit balance of medical choices. The aim of this report was to investigate how the disruption of usual activities impacted the features of differentiated thyroid cancers diagnosed after the outbreak by comparing the 12 months before and after March 2020. …