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.
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.
