Abstract
Purpose: Medullary thyroid cancer (MTC) is a less common cancer of the thyroid. Earlier diagnosis is associated with better survival and patient outcomes with less treatment. This study evaluates how various demographic factors impact the stage of MTC at diagnosis.
Methods: 9,652 patients with MTC were analyzed within the National Cancer Database (NCDB) between the years 2004-2020. Demographics between those with early (I) or late-stage (IV) disease were compared including sex, race, Hispanic origin, primary insurance payer, median income, percentage with a high school degree, and facility type. Multivariate binary logistic regression analysis was performed with SPSS version 28 with a significance level of p < 0.05.
Results: Female patients were 68% less likely to be diagnosed with late-stage MTC than male patients (p=<0.001; 95% CI= [0.283-0.356]). Patients with an income >$63,000 were 23% less likely to be diagnosed with late-stage MTC than those with an income <$38,000 (p=0.024; 95% CI= [0.613-0.967]). Those with private insurance, Medicaid, Medicare, and other government insurance were less likely (65%, 57%, 67%, and 61% respectively) to be diagnosed with late-stage MTC compared with those who were uninsured (private insurance: p=<0.001; 95% CI= [0.241-0.510], Medicaid: p=<0.001; 95% CI= [0.284-0.655], Medicare: p=<0.001; 95% CI= [0.226-0.486], other government insurance: p=0.004; 95% CI= [0.210-0.744]). Patients treated at Integrated Network Cancer Programs (INCP) and Comprehensive Community Cancer Programs (CCCP) are less likely to be diagnosed with late-stage MTC than Academic/Research Programs (21% and 18% respectively), with no significant difference found with Community Cancer Programs (INCP: p=0.002; 95% CI= [0.674-0.917], CCCP: p=0.004; 95% CI= [0.717-0.940]). No significant difference was found between race, Hispanic origin, or percentage with a high school degree.
Conclusions: Patients who are male, uninsured, have low socioeconomic status, or are treated at Academic/Research Programs are more likely to be diagnosed later than their counterparts. This data demonstrates demographics that may influence whether a patient is diagnosed with a favorable, early-stage MTC or a late-stage MTC that results in worsened outcomes. Identifying these possible inequities contributes to a greater understanding of social determinants of health. Literature on such inequities can be used to advocate for better care for our cancer patients.
Citation Format: Darby Keirns, Beau Hsia, Peter Silberstein, Xinxin Wu. Who Gets Diagnosed Later? Demographic Differences in Early Vs. Late-Stage Medullary Thyroid Carcinoma: A NCDB Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 97.
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