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Thyroid Leadership Team

L-R: Dr. David Barnes, Dr. Murali Rajaraman, Dr. Ali Imran

Excellence in patient care, excellence in thyroid cancer treatment

Five years ago, there was no one place for thyroid cancer patients to go for information, treatment and support. Today, the Interdisciplinary Thyroid Oncology Clinic (ITOC) sees 500 to 600 patients a year – and provides each of them with coordinated, ongoing care for the 12 years of follow-up these patients require after treatment.

“Patients no longer have to see four different specialists in four different places at four different times, says Dr. Murali Rajaraman, a radiation oncologist with Capital Health. “It’s one-stop care, ensuring a consistent approach with a focus on the needs of the patients.”

The need for one-stop, integrated care for thyroid cancer is growing as the rate of thyroid cancer is increasing faster than any other cancer. Fortunately, the prognosis is good. The five-year survival rate for most patients is 99 per cent. “However, there are significant recurrence rates” says Dr. Rajaraman. “Also, this is a cancer that affects a younger population – 15 to 50 years olds predominantly – and they will be followed for life.”

However, prior to the establishment of the thyroid oncology clinic in February 2005, Dr. Ali Imran, an endocrinologist at Capital Health, says, “Care was not well coordinated, information was inconsistent, and time was wasted for both patients and health care providers.”

This is no longer the case. In fact, the IOTC Team’s commitment to quality and excellence in patient care earned them CCNS’s 2009 Excellence in Patient Care Award. The team’s membership includes more than a dozen health care and support professionals including physicians trained in radiation oncology, nuclear medicine, otolaryngology – head and neck surgery and endocrinology; nurses; medical radiation technologists; nuclear medicine technicians; dieticians; and administrative staff. They work together to provide comprehensive care to each patient.

As one patient noted, “Once you have thyroid cancer, it is for life, so you are part of the team. They work with me as a whole person and not just as a test result, and this is huge to me.”

Operating one day a week from the VG Site of the Queen Elizabeth II Health Sciences Centre, the clinic has streamlined patient care for both newly diagnosed patients and those requiring follow-up. Following surgery, thyroid cancer patients are referred to the clinic through a single referral point and are assessed by endocrinology, radiation oncology, and nuclear medicine specialists.

The clinic was originally established by Dr. Rajaraman, Dr. Imran and Dr. David Barnes, a nuclear medicine specialist, and has benefitted from the recent addition of surgical expertise from Dr. Rob Hart. Patients at the clinic receive extensive information on the disease, treatment and lifestyle approaches.

“Patients receive clear and timely communication about upcoming tests and appointments, and if they are having any issues related to their thyroid, they know they can call a main number and receive assistance,” says Dr. Imran. “We want them to feel valued as a patient and as a person.”

As demand for the clinic’s services increases, the clinic team is preparing for challenges in moving to the next phase in its development. “We are looking to move to the next level,” notes Dr. Imran. “This will require additional resources and greater coordination.”

The benefits will be significant. A study conducted by the team comparing wait times before and after establishment of the clinic found that although wait times from final surgery to first post-op consultation rose, there was a decrease in overall time from surgery to completion of all post-op consultations: 651 to 177 days.  There was also improved (30% vs. 71%) and more timely (698 vs.143 days) access to endocrine consultation and a reduction in the frequency of hospital visits. 

The greatest benefit, however, is how patients feel when they are part of the clinic. “Patients and their families are always wondering if specialists are communicating with one another,” says Dr. Rajaraman. “It is invariably reassuring to them to see specialists in one spot and to know those specialists are working together – for them."