Following completion of endocrine surgery fellowship, the candidate joined the surgical oncology staff at the Massachusetts General Hospital and was appointed at Harvard Medical School in 2010. Since 2010, she achieved a Master of Public Health degree, established productive relationships with her mentors through the Program in Cancer Outcomes Research Training fellowship, and was promoted to Assistant Professor. This Career Development Award is motivated by the public health importance of thyroid cancer, which affects over 1/2 million Americans and is increasing in incidence and prevalence. Substantial morbidity and societal cost are attributable to papillary thyroid carcinoma (PTC). While the incidence of PTC is increasing faster than any other cancer, the majority of new diagnoses is patients with small tumors in a low-risk population, and disease-specific mortality remains low and unchanged. Given the relatively low disease- specific mortality, the length and cost of clinical trials with survival as the primary endpoint in this population are prohibitive. Te majority of clinical practices are, therefore, based on consensus alone. The candidate seeks to address these knowledge gaps by constructing a comprehensive computer model to simulate individuals in the U.S. population. Specifically, the candidate proposes to: 1) develop a decision- analytic model to simulate the natural history of papillary thyroid cancer in both untreated and treated patients; 2) conduct studies to inform key model parameters where data are currently lacking using primary patient data to develop a prediction algorithm for recurrence of PTC integrating knowledge of BRAF mutational status as well as patient-reported HRQoL data; and 3) evaluate and compare effects of standard versus alternate management strategies on outcomes, including risk-stratified approaches to treatment and surveillance on health and economic outcomes. The central hypothesis is that integrating improved risk-stratification and a tailored approach to treatment and surveillance will optimize quality of care and resource utilization while minimizing over-diagnosis and over-treatment for patients with PTC. This K07 is designed to foster independence through advanced training in decision analysis, survey science, and biostatistics as well as effective and productive mentoring relationships. The application draws upon strengths of a diverse group of experienced mentors in a multidisciplinary fashion.
The aims will inform our understanding of the health and economic consequences of our current `clinical practices in the treatment of patients with PTC. Ultimately, we will identify individuals likely to benefit from more aggressive diagnostic and surgical approaches and reduce morbidity both from recurrent disease and ineffective medical and surgical interventions. With the skills and groundwork obtained during the K07 award period, the candidate will be prepared to submit a competitive R01 application.

Public Health Relevance

Thyroid cancer is common and is increasing in incidence, prevalence, and societal cost; yet, the effects of current clinical practice are unknown. The proposed comprehensive simulation model of individuals with thyroid cancer in the U.S. population is a powerful, systematic approach to evaluating the impact of current interventions and future advancements in the diagnosis, treatment, and surveillance strategies on patients with papillary thyroid cancer. We aim to identify those strategies that have the most promise for increasing both length and quality of life, while optimizing care and minimizing harm to our patients.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Academic/Teacher Award (ATA) (K07)
Project #
5K07CA177900-04
Application #
9312666
Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Perkins, Susan N
Project Start
2014-08-01
Project End
2019-07-31
Budget Start
2017-08-01
Budget End
2018-07-31
Support Year
4
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02114
Gartland, Rajshri M; Lubitz, Carrie C (2018) Impact of Extent of Surgery on Tumor Recurrence and Survival for Papillary Thyroid Cancer Patients. Ann Surg Oncol 25:2520-2525
Gartland, Rajshri M; Lubitz, Carrie C (2018) Reply to ""Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on the Outcomes of Lobectomy"". Ann Surg Oncol :
Lubitz, Carrie C; Zhan, Tiannan; Gunda, Viswanath et al. (2018) Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma. Thyroid 28:328-339
Rossi, Esther Diana; Mehrotra, Swati; Kilic, Ayse Irem et al. (2018) Noninvasive follicular thyroid neoplasm with papillary-like nuclear features in the pediatric age group. Cancer Cytopathol 126:27-35
Mainthia, Rajshri; Wachtel, Heather; Chen, Yufei et al. (2018) Evaluating the projected surgical impact of reclassifying noninvasive encapsulated follicular variant of papillary thyroid cancer as noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Surgery 163:60-65
Lubitz, Carrie; Ali, Ayman; Zhan, Tiannan et al. (2017) The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population. PLoS One 12:e0177068
Loehrer, Andrew P; Murthy, Shilpa S; Song, Zirui et al. (2017) Association of Insurance Expansion With Surgical Management of Thyroid Cancer. JAMA Surg 152:734-740
Lubitz, Carrie C; De Gregorio, Lucia; Fingeret, Abbey L et al. (2017) Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma. Thyroid 27:197-206
Lubitz, Carrie C; Parangi, Sareh; Holm, Tammy M et al. (2016) Detection of Circulating BRAF(V600E) in Patients with Papillary Thyroid Carcinoma. J Mol Diagn 18:100-8
Lubitz, Carrie C; Economopoulos, Konstantinos P; Sy, Stephen et al. (2015) Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circ Cardiovasc Qual Outcomes 8:621-30