ArticleJAMA otolaryngology-- head & neck surgery2019
Explaining the Variation in Surgical Practice for Differentiated Thyroid Cancer in Ontario, Canada.
Article in JAMA otolaryngology-- head & neck surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it, 9 citations in OpenAlex.
- 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer.Thyroid : official journal of the American Thyroid Association · 2025Guideline
- Differential Ultrasound Rates Mirror Sex Disparities in Thyroid Cancer.Thyroid : official journal of the American Thyroid Association · 2024Article
- Urban and Rural Surgical Practice Patterns for Papillary Thyroid Carcinoma.Thyroid : official journal of the American Thyroid Association · 2023Article
- Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
importanceIn the management of differentiated thyroid cancer (DTC), the extent of surgical treatment required for most patients remains controversial and varies widely. This variation may be associated with the Enthusiasm Hypothesis, the notion that geographic differences in use of health care services are driven by the prevalence of physicians with a preference for particular services.
objectiveTo evaluate the Enthusiasm Hypothesis and its applicability to the variation in the surgical treatment of thyroid cancer in Ontario, Canada. DESIGN, SETTING, AND
participantsThis population-based study obtained electronic data on all health care-associated events for the complete population of insured residents of Ontario, Canada. Patients (n = 28 754) who were 18 years of age or older and underwent an initial therapeutic thyroid surgical procedure for a papillary or follicular carcinoma diagnosis between January 1, 2000, and December 31, 2015, were included. The final data analysis was performed January 31, 2019. EXPOSURES: Therapeutic thyroid cancer surgical procedure. MAIN OUTCOMES AND MEASURES: Numbers of surgeons, extent of surgical treatment, and case volumes in 14 geographic regions in Ontario.
resultsIn total, 28 754 patients with DTC were included, of whom 22 600 (78.6%) were female, with a mean (SD) age of 49 (14) years. The use of total thyroidectomy for DTC varied widely across geographic regions of Ontario, from 45.8% to 77.1% of all cancer cases. More than 90% of the overall variation in practice (total thyroidectomy vs less-than-total thyroidectomy) could be explained by the practices of the high-volume surgeons (enthusiasts) in regions with the highest rates of thyroid cancer diagnosis. CONCLUSIONS AND RELEVANCE: The Enthusiasm Hypothesis appears to be consistent with the findings of this study. The practices of the high-volume surgeons who were enthusiastic for total thyroidectomy in the geographic regions with the highest rates of thyroid cancer diagnosis may account for the variation in practice across Ontario between 2000 and 2015.
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Registered trials
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