Presentations

2014

Are we over treating lower risk thyroid cancer? 
Can Otolaryngology Society, Ottawa
A population-based study of 2444 patients with tumors <=4 cm demonstrating no difference in patient outcomes between regions with higher rates of total thyroidectomy and RAI vs regions with less aggressive treatments.  We are over treating differentiated thyroid cancer.

30 day readmission rates in Otolaryngology: an example of a departmental Quality Improvement Plan.
Peng Y, Hall SF, Hollins R.
Canadian Otolaryngology Society, Ottawa
Based on CIHI data, this study demonstrated that 30 day readmissions and visits to the ER after ENT surgery could be determined and that rates in Kingston Ontario were low for most procedure groups except head and neck surgery

Access and the overdiagnosis of thyroid cancer. Preventing Overdiagnosis.
Oxford, UK.
The increasing incidence of thyroid cancer is due to the increasing use of discretionary diagnostic tests such as ultrasound.

Overstaging and over treatment: an example from thyroid cancer. Preventing Overdiagnosis.
Oxford, UK.
In the management of differentiated thyroid cancer, the presence of involved neck nodes does not influence survival but does influence in the use of adjuvant RAI.   The data in this presentation demonstrates how increased node sampling by surgeons in some regions of Ontario lead to more RAI treatments yet no difference in outcomes compared to regions with less sampling.

2013

Practice Patterns in the management of patients with differentiated thyroid cancer in Ontario Canada 2000-2008.
Canadian Surgical Forum, Ottawa.
A population based description of the wide variation in treatment over the first year after diagnosis across Ontario between 2000-2008 based on 12,795 patients using ICES data.

Oropharynx cancer on Ontario 2003/4: treatments and results.
The Canadian Otolaryngology Society. Banff, Alberta
Presentation of initial results of NCIC # 19174  presenting data on 571 patients from Ontario in 2003/4 treated for cancer of the oropharynx demonstrating that the addition of chemotherapy to radiotherapy had no impact on survival or site of recurrence.

What do patients think of routine followup after curative cancer treatment?
The Canadian Otolaryngology Society. Banff, Alberta
A review of why follow-up is important, why it needs to be changed and initial data on 46 patients from survey on patient needs, preferences, attitudes and fears at the time of followup appointments.

2012

The concept of over-diagnosis and the case for thyroid cancer. 150th Anniversary of the Royal Columbian Hospital. New Westminster, BC
The concepts of incidence, prevalence and over-diagnosis  are reviewed in association with research and the current literature to better understand some of the background to current controversies the management of thyroid cancer.

Extent of treatment for thyroid cancer in Ontario Canada 2000-2008.
The American Head and Neck Society: Lunch with the Professor.   Toronto, ON
A population-based study of 13000 patients using ICES data holdings describing the surgery, RAI treatments and the variation in those treatments by geographic regions for patients with thyroid cancer across Ontariociety.

Patterns of Practice in the management of thyroid cancer in Ontario 2000-2008
The Clinical Council of Cancer Care Ontario
A population-based study of 13000 patients using ICES data holdings describing the surgery, RAI treatments and the variation in those treatments by geographic regions for patients with thyroid cancer across Ontario

Access or Excess:  what is driving the increasing incidence of thyroid cancer?
Canadian Otolaryngology Society
A population-based study of 13000 patients using ICES data holdings demonstrating a 112% increase in cases over 8 years. The rates of diagnosis vary across the geographic regions of Ontario with the populations of the Toronto LHINs having the highest detection rates. The variation in detection rates are related to the variation in the of use of diagnostic ultrasound (neck, abdomen and pelvis) in populations with higher education, urban location, and better overall health.

Treatment variation, evidence and lessons learned in Head and Neck Oncology
Canadian Otolaryngology Society
A review of 4 population-based research projects (hypopharynx, oropharynx, all H&N patients, thyroid) that highlight the surprising variations in treatment yet little differences in outcome. The evidence around each project, theories on area variations and how doctors make decisions in the absence of evidence are reviewed. The hypothesis of Enthusiasm may help explain our collective behaviour.
References:
Inappropriateness:
Chassin MR, Kosecoff J, Park R.   Does in appropriate use of explain geographic variations in the use of health care services?  JAMA 1987,  258:  2533
Lack of Consensus:
Wennberg J. The Paradox of Appropriate Care. JAMA 1987;(258):2568-2569. and Wennberg J. Dealing with medical practice variation:  A proposal for action. Health Affairs 1988; 7:6-32
Uncertainty:
Eddy D. Variations in physicians practice: the role of uncertainty. Health Affairs 1984; 74.
Enthusiasm:
Chassin MR. Explaining geographic variations: the Enthusiasm Hypothesis. Medical Care 1993; 31:YS37-YS44.

Incidence, Overdiagnosis and Lead-time Bias: epidemiology meets thyroid cancer.
Canadian Otolaryngology Society
The concepts of incidence, prevalence, overdiagnosis and lead-time bias are reviewed in association with research and the current literature to better understand some of the background to current controversies the management of thyroid cancer.
References:

  1. Chen A, Ward E, Jemal A. Increasing incidence of differentiated thyroid cancer in the United States, 1998-2005. Cancer 2009; 115:3801-3807.
  2. Davies L, Welch H. Increasing incidence of thyroid cancer in the United States. JAMA 2006; 295:2164-2167.
  3. Davies L, Welch H. Thyroid cancer survival in the United States. Arch Oto Head Neck Surg 2010; 136:444-446.
  4. Davies L, Ouellette M, Hunter M, etal. The increasing incidence of small thyroid cancers:  Where are they coming from? Laryngscope 2010; 120:2446-2451.
  5. Hall S, Walker H, Seimens R, Schneeberg A. increasing detection or increasing incidence in thyroid cancer. World J Surg 2009; 33:2567-2571.
  6. Harach H, Franssila K, Wasenius V. Occult papillary carcinoma of the Thyroid:  a “normal” finding in Finland. Cancer 1985; 56:531-538.
  7. Ito Y, Uruno T, Narayan S, etal. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. thyroid 2003; 13(4):381-387.
  8. Ito Y, Miyauchi A, Inoue H, etal. An observational trial for papilaary microcarcinoma in Japanese patients. World J Surg 2010; 34:28-35.
  9. Kent W, Hall S, etal. The increasing incidence of Differentiated Thyroid Cancer is due to increased detection of subclinical disease. CMAJ 2007; 177(11):1357-1361.
  10. Takebe K, Date M, Yamamoto Y. Mass screening for thyroid cancer with ultrasonography. Karkinos 1994; 7:309-317.
  11. Welch G, Black W. Overdiagnosis in Cancer. J Natl Cancer Inst 2010; 102:605-613.

Patterns of Practice in the management of thyroid cancer in Ontario 2000-2008
Toronto Endocrine Communities of Practice, Toronto Central Regional Cancer Program of Cancer Care Ontario.
A population-based study of 13000 patients using ICES data holdings describing the surgery, RAI treatments and the variation in those treatments by geographic regions for patients with thyroid cancer across Ontario. Presentation highlights the difference in practice between the Toronto regions and the rest of the province.

2011

Does geography matter in the diagnosis and management of thyroid cancer in Ontario?
Center for Research in Healthcare Engineering, Dept of Mechanical and Industrial Engineering, University of Toronto.
A population-based study of 13000 patients using ICES data holdings describing the surgery, RAI treatments and the variation in those treatments by geographic regions for patients with thyroid cancer across Ontario. The Populations of the Toronto LHINs have more diagnostic tests and thus a higher detection rate of thyroid cancer.

Incidence, Detection and Lead time bias: adventures in thyroid cancer research
Guest speaker, Department of Otolaryngology, University of Ottawa

Patterns of Practice in the management of thyroid cancer across Ontario 2000-2008.
Canadian Otolaryngology Society
A population-based study of 14000 patients demonstrating huge variations in the detection and treatment by political/geographic regions of Ontario. Otolaryngologists do more cases and do more extensive surgery than general surgeons.

Where are the men with thyroid cancer?
Kingston General Hospital Research Day
A series of research projects on the theme that thyroid cancer incidence is related to detection and as men have fewer diagnostic tests, they have a lower incidence of thyroid cancer.

2010

What influenced the extent of surgery for differentiated thyroid cancer?
Canadian Otolaryngology Society
A population based study demonstrating that in Ontario surgical specialty, patient address, gender and histological type determined extent of surgery not tumor size or age.

Treatment variation in Head and Neck Surgery – when, why and so what?
Nova Scotia Cancer Society Guest Speaker
Based on multiple studies as examples, we can use variations in treatment to assess treatment effectiveness.

Incidence, detection and bias: adventures in thyroid cancer research.
Dept of Otolaryngology, Dalhousie University.

Where are the men with thyroid cancer?
Canadian Otolaryngology Society

2009

How to write a successful research grant application.
Canadian Otolaryngology Society

Differentiated thyroid cancer in Ontario: A population based study.
World Thyroid Cancer Congress.
There is variation in tumor size and treatment across geographic regions with a curious inverse relationship. Otolaryngologists do more cases and more extensive surgery than general surgeons.

Prognostic factors and Biases and head and neck oncology.
University of Calgary.