Multidisciplinary Care for Anaplastic Thyroid Cancer-End-of-Life Care as a Standard of Care

Anaplastic thyroid cancer (ATC) is an aggressive and potentially fatal thyroid malignancy. Clinical guidelines recommend that all ATC patients be evaluated by a multidisciplinary team, including palliative care specialists, with treatment decisions reflecting patients' evolving goals of care (GOC). This study aimed to investigate patterns of palliative care referrals and GOC documentation in advanced ATC patients treated with newer targeted therapies and immunotherapies.

Retrospective cohort study of 58 ATC patients diagnosed between 2000 and 2023 at a single quaternary medical center. Data on demographics, treatments, palliative care referrals, and GOC discussions were collected by chart review and analyzed using Fisher's exact test, Wilcoxon rank-sum tests, Kaplan-Meier survival analysis, and multivariate logistic regression.

Mean age at diagnosis was 69.2 years, with 50% female. A minority of patients were referred to palliative care a median of 45 days before death. Only 36.2% had a documented GOC discussion, with the first occurring a median of 53 days post-diagnosis. Targeted therapy/immunotherapy was significantly associated with palliative care referrals (p = 0.004) and radiotherapy with GOC discussions (p < 0.001). Multivariate regression showed that targeted therapy/immunotherapy was independently associated with palliative care referral (p = 0.04).

Despite national guidelines, many ATC patients do not receive timely palliative care referrals. The relationship between targeted therapies and higher rates of palliative care referrals and GOC discussions merits further study.