Christos Melidis

Background Publicly available cancer indicators are increasingly used to guide regional health-care planning and investment. Their robustness for decision-making in remote or insular regions remains insufficiently examined. Methods We analysed publicly available incidence, mortality, standardised incidence ratios, standardised mortality ratios, mortality-to-incidence ratios (MIR), premature mortality and temporal trends using Corsica as a stress test and comparing with other French regions using national datasets. Indicators were compared using confidence intervals, temporal aggregation and rank-stability analyses. No causal inference was attempted. Results Across multiple indicators, Corsica’s relative position varied substantially depending on indicator choice, time window and statistical representation. Several indicators showed wide confidence-interval overlap with most French regions and marked rank instability, despite large apparent position changes. MIR and trend-based indicators were particularly sensitive to temporal aggregation and data structure. Discussion Our findings suggest that commonly used national cancer indicators are frequently insufficiently robust to support decision-grade regional planning in remote settings. Apparent “good” or “poor” performance in such contexts can reflect statistical instability rather than meaningful differences. Conclusion For remote regions, cancer indicators should be interpreted with particular caution. Routinely published cancer indicators are insufficiently robust to support decision-grade regional health-care planning in small or insular populations.

Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to investigate the role of Sestamibi scintigraphy in the characterization of cytological indeterminate thyroid nodules. Materials and Methods: A focused literature review was conducted, emphasizing the comparison between Fine Needle Aspiration Biopsy (FNAB), the main diagnostic method for thyroid cancer, and Sestamibi. Results: It is widely accepted that Sestamibi is the primary alternative for patients with non-diagnostic FNAB. As shown in the literature, Sestamibi has a high negative predictive value in excluding thyroid malignancy. Conclusions: Much like Odysseus’ adventurous 10-year journey returning to Ithaca, the path to diagnosing thyroid cancer is not straightforward. Molecular imaging with 99mTc-Sestamibi may serve as a valuable adjunct in evaluating thyroid nodules with inconclusive cytological findings.

Background: Thyroid cancer is the most common malignant disease of the endocrine system and radioiodine therapy (RAIT) is still very often used, resulting in patients staying hospitalized for a few days alone and without visitors, augmenting their stress and discomfort. Our objective was to find simple ways of improving RAIT patients’ feelings and perceived quality of the nuclear medicine (NM) department services. Material and methods: We designed a two-year study in order to enhance RAIT patients’ perceived quality of the nuclear medicine (NM) department services and expectations’ fulfillment. A questionnaire was used in order to capture patients’ perceived quality and expectations from their RAIT. Results: 549 replies were collected. Many intrinsic and extrinsic determinants were found to be positively or negatively related to the perceived quality and fulfillment of patients’ expectations of receiving RAIT. A 1% increase could be achieved by spending 110 € per RAIT room. Conclusions: In this article, we present some easily implemented changes in both personnel behavior and room amenities that could, at least in theory and based on our results, offer a 37.9% improvement in RAIT patients’ perceived quality and expectations’ fulfillment at a cost of 4169 €. Background: Thyroid cancer is the most common malignant disease of the endocrine system and radioiodine therapy (RAIT) is still very often used, resulting in patients staying hospitalized for a few days alone and without visitors, augmenting their stress and discomfort. Our objective was to find simple ways of improving RAIT patients’ feelings and perceived quality of the nuclear medicine (NM) department services. Material and methods: We designed a two-year study in order to enhance RAIT patients’ perceived quality of the nuclear medicine (NM) department services and expectations’ fulfillment. A questionnaire was used in order to capture patients’ perceived quality and expectations from their RAIT. Results: 549 replies were collected. Many intrinsic and extrinsic determinants were found to be positively or negatively related to the perceived quality and fulfillment of patients’ expectations of receiving RAIT. A 1% increase could be achieved by spending 110 € per RAIT room. Conclusions: In this article, we present some easily implemented changes in both personnel behavior and room amenities that could, at least in theory and based on our results, offer a 37.9% improvement in RAIT patients’ perceived quality and expectations’ fulfillment at a cost of 4169 €.

Over the last few decades, thyroid cancer incidence has had a significant increase. Despite well-known genetic and epigenetic factors (radiation, overdiagnosis, already existing benign thyroid tumors), the effect of air pollution on its incidence and mortality has not yet been fully elucidated. In this study, air pollution data from 27 EU member states is used in order to analyze its association with thyroid cancer incidence, and mortality and socioeconomic factors are examined as confounders. This ecological study used age standardized thyroid cancer incidence and mortality rates per 100,000 people for the year 2012 from 27 EU member states, collected from the International Agency for Research on Cancer, World Health Organization and European Cancer. Data regarding mean air pollutant mass concentrations for 1992, 2002 and 2012 was collected from the European Environment Agency. Data analysis was carried out using Prism 5.0 and SPSS v.20. Multiple regression analysis showed a statistically significant positive association between thyroid cancer incidence in men and the environmental 2012 masse of Benzo (k) Fluoranthene (r² = 0.2142, p = 0.042) and HexaChlorocycloHexane (r² = 0.9993, p = 0.0166). Additionally, a statistically significant positive association was observed between the thyroid cancer mortality rate in men and the 1992 environmental concentrations of Hg (r² = 0.1704, p = 0.043). Data indicates that some air pollutants may have an effect on increased thyroid cancer incidence and mortality, at least in men. However, causal relationships cannot be fully supported via ecological studies, and this article only focuses on the EU and uses only three distinct time periods.

Prognosis in Differentiated Thyroid Cancer (DTC) patients is excellent, but a significant degree of overtreatment still exists because of the inability to accurately identify small patient cohorts who experience a more aggressive form of the disease, often associated with certain poor prognostic factors. Identifying these cohorts at an early stage would allow patients at high risk to receive more aggressive treatment while avoiding unnecessary and invasive treatments in those at low risk. Most risk stratification systems include age, tumor size, grade, presence of local invasion, and regional or distant metastases. Here we discuss these common factors as well as their association with treatment response, but also other upcoming markers including histology and multifocality of primary tumor, dose administered and preparation method for Radioiodine Therapy (RAI), Thyroglobulin (Tg), Anti-thyroglobulin Antibodies (Tg-Ab) levels both at initial management and during follow-up, and the presence of previously existing benign thyroid disease. In addition, we examine the role of remnant size and avidity as well as surgeons’ experience in performing thyroidectomies with recurrence rate, discussing its impact on disease prognosis. Our results reveal that treatment response has a statistically significant association with histology, T and M stages, surgeons’ experience, Tg levels and remnant score both during RAI and follow up and Tg-Ab levels during follow-up whole body scan (WBS).

National and international authorities and societies have recently published important cancer treatment recommendations in order to propose extra measures that should be taken during the COVID‑19 pandemic, such as prioritisation of intend‑to‑cure treatments and younger patients, omission of non‑urgent cases, and reduction of personnel present. These measures raise important ethical considerations, since they prioritise protection of Health Systems and Professionals without seemingly taking cancer patient feelings of stress into consideration. This could lead to an erosion of the physician‑patient relationship, which is considered the core element of medical ethics. Moreover, they raise practical concerns about the continuous education of Health Professionals, the status of reference centres and the evaluation of the hitherto cancer treatments.