MON-551 Immediate Cause Of Death In Patients With Thyroid Cancer Progression

Background: Although thyroid cancer is considered to have generally a good prognosis, approximately 2000 patients a year die as a consequence of progressive disease. Understanding the conditions arising from thyroid cancer progression and directly contributing to death could improve and personalize therapeutic and palliative treatment in patients with aggressive disease. Material and methods: Information from 586 deceased patients with thyroid cancer treated in MedStar facilities from 1986 to 2018 were obtained from MedStar Cancer Registries. Data from patients coded with cancer related death were extracted and analysis of clinical and pathological data was performed. Charts were reviewed to obtain information regarding the precipitating cause of death. Results: A pool of 71 patients with thyroid cancer related cause of death was obtained, of whom 35 were female (49%) and 36 male (51%). Histopathology analysis revealed 23 (32%) papillary thyroid cancer, 14 (20%) follicular variant papillary cancer, 11 (15%) follicular thyroid cancer, 3 (4%) poorly differentiated, 13 (18%) anaplastic, 3 (4%) medullary thyroid cancer and 1 (1%) squamous cell carcinoma. Staging was possible for 42 patients: (31% stage I, 7% STAGE II, 5% STAGE III, 57% STAGE IV). As initial management, 50% of the patients had total thyroidectomy, 13 % subtotal, 10% lobectomy and 24% did not undergo surgery. 78% of the differentiated thyroid carcinoma (DTC) patients had been treated with I-131 therapy and 34% of all the patients received external beam radiation therapy. For patients with DTC, age at diagnosis (mean ± 2 SD) was 55 ± 15 years old, and the mean age at the time of death was 64.86 ± 10 years old with a mean survival after diagnosis of 9.5 years. For anaplastic thyroid cancer, mean age at diagnosis was 76.6 ± 8.5 years old and mean age at the moment of death was 77.39 ± 13 years old with a mean survival of 0.77 years. The precipitating cause of death was identifiable in 24 patients. The main precipitating event was respiratory insufficiency (50%) mainly triggered by pneumonia, followed by upper airway obstruction (17%) and stroke and/or brain hemorrhage (17%). Other causes included septic shock (13%) (mainly related to gastrointestinal obstruction or perforation) and multiple organ failure in (4%). At the time of death 69% of patients had lung metastasis, 54% bone metastasis, 59% brain metastasis, 15% liver metastasis, 10% muscle metastasis, 8% peritoneum metastasis and 8% other locations (eye, adrenal, kidney). Conclusion: Death from thyroid cancer does occur, and death in patients originally considered as Stage 1 raises question of the utility of the existing thyroid cancer staging system. The spectrum of causes of death in these patients (respiratory insufficiency, airway obstruction, brain hemorrhage and stroke) provides insight into potential end of life planning and management in patients with progressive thyroid cancer.