Best Supportive Care from the Conservative/Non-Surgical Perspective and Its Costs in the Treatment of Patients with Advanced Medullary Thyroid Cancer: Results of a Delphi Panel

Abstract

Background: Medullary thyroid cancer (MTC) is a rare tumor entity. The contents of best supportive care (BSC) have not been defined in advanced MTC. The objective of this work is to describe the epidemiology, the treatment patterns with respect to symptom management, as well as palliative treatment and associated costs. Method: A Delphi panel with 9 clinical experts experienced in treating MTC was conducted to obtain details on the epidemiology of MTC and to gain insights into the therapeutic options considered for BSC in advanced MTC in Germany. Unit costs were applied to the described resources from the perspective of the German National Healthcare System in 2011. Results: The annual incidence of MTC in Germany was estimated at about 220. 32% of all patients were estimated to have aggressive/symptomatic MTC, with an estimated mean survival of 36.7 months (median: 36 months). The core element of BSC is relief of symptoms to maintain quality of life. The total mean cost of BSC per patient/year was estimated at € 9,248, lifetime cost at € 28,283. Conclusion: There was consistent agreement within the panel on the epidemiology of MTC and on the structure of the provided therapeutic measures for BSC in advanced MTC, also defining the management of symptoms as a crucial goal of treatment.

Systemic treatment of advanced differentiated and medullary thyroid cancer

“…Patient education before the initiation of therapy plays a major role since the likelihood and severity of the most common toxicities of this class of drugs may be reduced by simple preventive means. In addition, general supportive measures should be considered to improve further the patient's quality of life (47). All patients potentially in need for systemic therapy should be discussed in an interdisciplinary tumor board.…”