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The Impact of Low-to-intermediate Risk Thyroid Cancer Diagnosis and Treatment on the Patient’s Quality of Life – a cross-sectional study to facilitate assisted decision-making and peer-group benchmarking

Description 
The incidence of thyroid cancer has been on the rise over the last 3 – 5 decades worldwide. It is the most common type of endocrine cancer worldwide. A recent study extracted data from the Global Health Data Exchange to determine the global burden of thyroid cancer from 1990 to 2017. The online data exchange includes data from 195 countries and territories, and 354 human diseases and injuries. The study found increases in thyroid cancer incidence, disease-specific deaths, and disability-adjusted life-years (DALYs), over the study period of nearly 30 years. Of note, a significant portion of the thyroid cancer burden fell on women, accounting for 70% of the total incidence, 58% of deaths, and 59% of DALYs. Overall, the findings of the international study is consistent in the Australian population, where there is a large population of thyroid cancer survivors, and that number is increasing. According to Australian Institute of Health and Welfare data, between 1982 and 2019, the incidence of thyroid cancer in Australia has increased 392% from 2.7 to 13 per 100,000 persons. This number is likely to continue to rise. The corresponding mortality remains low, with reported 5-year survival rates as high as 97%.(Australian Institute of Health and Welfare, 2019) It has been projected that by the year 2030, in the United States, thyroid cancer will replace colorectal cancer as the 4th most common cancer diagnosis, following breast, prostate and lung cancers.(Rahib et al., 2014) After the initial treatment, all except the very low-risk patients would require long-term surveillance, as recurrence after a 10-year disease-free period is not uncommon. In fact, while disease-specific mortality risk is low for the majority of thyroid cancer patients, recurrence rate is as high as 20% at 10 years. Together, these trends lead to a rising number of thyroid cancer survivors. The health-related quality of life (HRQOL) of this growing community of patients with newly-diagnosed thyroid cancer and long-term survivors is a theme identified by the American Thyroid Association (ATA) for future research. The Australian & New Zealand Thyroid Cancer Registry (ANZTCR) is a clinical quality registry, managed by the Cancer Research Program in the School of Public Health and Preventive Medicine at Monash University. It is designed to describe patterns of care following diagnosis of thyroid cancer and identify variation in the management, treatment and outcomes of patients with thyroid cancer, with a view to improving patient outcomes and quality of care. Currently, the registry is in the process of expanding data collection to include patient-reported HRQOL information. With this information, the registry is in a position to provide a fuller picture of both the quality of care and quality of life of thyroid cancer patients in the Australian setting. This project is designed with the collaboration and support of the ANZTCR in mind. The aim of this project is to build an online tool that can be used by patients and clinicians to assist the patients throughout their thyroid cancer journey. With that in mind, the tool is envisaged to serve two main purposes, by answering the respective patient-centred questions: 1. “What decision do other patients – with similar outlook on life – make in my current situation, and how satisfied are they with their decision?” In the pre-treatment phase, this is an adjunctive tool to help with the patient-doctor discussion and decision-making in situations where there is no clear evidence demonstrating a treatment modality to be advantageous over another. There are many such situations in the management of low-to-intermediate risk thyroid cancer. Recommended treatments in such situations all need to be balanced with the potential harmful effect of that recommendation. The aim is to avoid over- and under-treatment while achieving high satisfaction and optimal clinical outcomes. 2. “Are the symptoms I experience expected at this stage of my journey or a potential concern?” In the post-treatment period, the patient may experience a range of symptoms and feelings, from minor to severe. Some may need immediate medical attention, but others may be part and parcel of the disease process or treatment. By extensively collecting patient-reported information on all aspects of their health, beyond just clinical symptoms, and applying machine learning techniques, the tool has the potential to help benchmark a patient against their peers. Depending on the outcome, the patient may be recommended to seek medical advice sooner rather than later, or be reassured until their next scheduled appointment.
Essential criteria: 
Minimum entry requirements can be found here: https://www.monash.edu/admissions/entry-requirements/minimum
Keywords 
Thyroid Cancer; Patient Reported Outcomes; Health Related Quality of Life; Assisted Clinical Decision Making; Patient Centred Care; Cancer Survivorship;
School 
Central Clinical School » Surgery - Alfred
School of Public Health and Preventive Medicine » Epidemiology and Preventive Medicine
Available options 
PhD/Doctorate
Masters by research
Masters by coursework
Honours
Time commitment 
Full-time
Part-time
Top-up scholarship funding available 
No
Physical location 
Alfred Centre, The Alfred Hospital
Co-supervisors 
Dr 
Liane Ioannou
Prof 
Jonathan Serpell
Prof 
Jeremy Millar

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