Multidisciplinary Management for the Treatment of DTC

Lori J. Wirth, MD: What is your takeaway message, in terms of the multidisciplinary care of patients with the more challenging thyroid cancer that we see?

Jennifer Sipos, MD: It’s critical that we take a multidisciplinary approach to these patients’ management because they are complex and there are a lot of factors to consider even before they get on a drug. There is also the determination of when is it appropriate to start a drug. Having regular conversations about those patients in some format—whether it’s informal talks, a formal tumor board with case presentations, or the ability to shoot messages back and forth in the electronic medical record—is critical. 

It’s really important that these patients be followed over time with a multidisciplinary approach. A surgeon, oncologist, and endocrinologist should be involved, because we always want to make sure something is not resectable before we start talking about this as progressive disease. If it’s resectable and progressing, then that’s certainly the easiest component to get rid of and perhaps the least morbid in some cases. Being able to distinguish whether something can be resected is important. Have a conversation with the surgeon to say, “Yes, there is disease that we could theoretically access, but it’s too morbid to remove,” or, “No, I can easily remove that. Don’t put them on a drug.”

Having those conversations is critical. Then have the conversation with the oncologist. They may say, “Yes, I know they could have another surgery, but this is their seventh surgery in 2 years. Maybe we need to think about using a drug, because now they’re getting pulmonary metastases.” We each bring something different to the table. Our viewpoints and the lenses that we use to see the world are different. It’s a critical component of managing these very complex patients and weighing the risks of a morbid treatment with the benefits. How much benefit are we going to get from that therapy? That’s a very important part of management of these complicated patients.

Lori J. Wirth, MD: I agree with you 100%, and you stated it well. We do bring our different viewpoints and our different expertise to bear on what is often a very complex patient problem that we’re dealing with. It offers the best that we can provide our patients while we’re working together. That’s 1 of the things that is really important about the multidisciplinary programs that we have for patients with advanced thyroid cancer.

Transcript edited for clarity.