Socioeconomic status and delayed surgery: impact on non-metastatic papillary thyroid carcinoma outcomes

The growing popularity of active surveillance for papillary thyroid cancer and the COVID-19 pandemic have increased surgery delay, further necessitating a reassessment of the link between surgery delay and survival outcomes for papillary thyroid cancer. In this study, we aim to investigate the interplay among various oncological factors, socioeconomic status, and surgical timing with respect to survival outcomes of papillary thyroid cancer.

A total of 58,378 non-metastatic papillary thyroid cancer patients from 2000 to 2018 were screened from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier survival curve, Cox proportional hazard regression, competing risk hazard regression, and multinomial logistic regression were applied.

Receiving neck dissection or radioactive iodine therapy, being married at diagnosis, living in an urban area, being richer, and being of other minority ethnicity were estimated to be independent predictors for better overall survival. Single, older Black patients living in rural areas that experienced long surgery delays were more associated with a higher non- papillary thyroid cancer mortality rate. High income level was the only independent socioeconomic status predictor for lower papillary thyroid cancer -specific mortality. Unmarried, older patients of minority ethnicity tended to undergo longer surgery delays.

Surgery for non-metastatic papillary thyroid cancer patients can be safely delayed. The elevated non-papillary thyroid cancer mortality has reflected low socioeconomic status population's survival status.