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Fast-track Radioiodine Ablation Therapy After Thyroidectomy Reduces Sick Leave in Patients With Differentiated Thyroid Cancer (FASTHYNA Trial)

Waissi, Farahnaz, MD*; Kist, Jakob W., MD, PhD*; Lodewijk, Lutske, MD, PhD*; de Wit, Ardine G., PhD; van der Hage, Jos A., MD, PhD; van Dalen, Thijs, MD, PhD§; de Keizer, Bart, MD, PhD; Valk, Gerlof D., MD, PhD; Borel Rinkes, Inne H. M., MD, PhD*; Vriens, Menno R., MD, PhD*

doi: 10.1097/RLU.0000000000002420
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Background Recombinant human thyroid stimulating hormone (RhTSH) aided radioiodine ablative therapy (RIT) is current-day practice in the treatment of differentiated thyroid cancer (DTC). It is often planned 4 to 6 weeks after surgery or sometimes even longer (standard protocol). The RhTSH-aided RIT, however, has the advantage that it can be planned shortly after thyroidectomy. The FASTHYNA trial was designed to test the hypothesis that RIT 1 week after thyroidectomy (fast-track protocol) results in a significant reduction of sick leave with lower societal costs and with a better quality of life (QOL) compared with the current standard treatment.

Methods In a randomized, multicenter trial, we included patients with differentiated thyroid cancer, stage T1–3 N0–1 M0-x, who were treated with a total or completion thyroidectomy, with a paid job of at least 12 hours per week. The primary study end point was days of sick leave reported from time of surgery. Secondary end points were QOL and societal costs associated with absence from work.

Results Twenty patients were eligible for inclusion between November 2013 and May 2016. Significant decreases in mean duration of sick leave in the fast-track group versus the standard care group (115 and 280 hours, respectively, P = 0.02) and in costs associated with productivity losses (€4070.77 vs €9202.90, P = 0.02) were found. There were no significant differences in QOL between both groups.

Conclusions The trial showed a significant reduction in sick leave and in societal costs in the fast-track group without a deterioration of QOL. Therefore, fast-track ablation is desirable.

Trial Registration: Netherlands trial register: NTR 3933.

From the *Department of Surgery and

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht;

Department of Surgical Oncology Cancer Institute-Antoni van Leeuwenhoek, Amsterdam;

§Department of Surgery, Diakonessenhuis Utrecht; and

Departments of Nuclear Medicine and

Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.

Received for publication August 22, 2018; revision accepted October 30, 2018.

Conflicts of interest and sources of funding: Unrestricted grant from Genzyme Corporation (Cambridge, MA).

Correspondence to: Menno R. Vriens, MD, PhD, Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands. E-mail: mvriens@umcutrecht.nl.

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