Implementing a Rapid Response Pathway for Anaplastic Thyroid Cancer in a Universal Healthcare System

To implement a multidisciplinary anaplastic thyroid cancer rapid response team (ARRT) pathway in a universal healthcare system and evaluate its impact on diagnostic and treatment timelines for patients with anaplastic thyroid cancer (ATC).

This quasi-experimental study was conducted at a tertiary care cancer center in Canada. We compared 26 consecutive adult patients with confirmed ATC: 11 patients in the pre-pathway period (January 2015-June 2020) and 15 in the post-pathway period (July 2020-July 2023). The ARRT pathway incorporated early identification of suspected cases, image-guided biopsies with rapid on-site cytology evaluation, expedited staging and molecular analysis, coordinated same-day multidisciplinary consultations, and early palliative care involvement. Outcomes included time from initial clinical suspicion to staging completion, multidisciplinary assessment, and treatment initiation.

The ARRT pathway significantly reduced median time from initial suspicion to staging completion from 21 days (IQR: 12-45) to 6 days (IQR: 2-9) (p < 0.01), time to multidisciplinary assessment from 28 days (IQR: 14-71) to 8 days (IQR: 6-14) (p < 0.01), and time to treatment initiation from 29 days (IQR: 18-83) to 18 days (IQR: 14-21) (p = 0.035). Post-pathway patients demonstrated greater consistency in rapid molecular testing (100% vs. 54%, p < 0.01) and higher rates of R0/R1 resection (4/4 patients [100%] vs. 1/6 patients [17%], p < 0.01).

The ARRT pathway reduced diagnostic and treatment delays for ATC patients within a universal healthcare system. This rapid response model demonstrates feasibility and effectiveness in improving care coordination for rare aggressive malignancies. The approach provides a replicable four-phase implementation framework for similar healthcare systems globally.

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