ATA Guidelines Tools

10 Treatment Palliative Care and Hospice Î The treatment team should include palliative care expertise at every appropriate stage of patient management to help with pain and symptom control, as well as addressing psychosocial and spiritual issues. Palliative care services are appropriate for any ATC patient receiving treatment intended to prolong life. (S-L) Î The treatment team should engage hospice care for ATC patients who decline therapies intended to prolong life yet still require symptom and pain relief spanning the remainder of their illness. (S-L) Surveillance and Long-Term Monitoring Î Following initial staging and therapy, patients without evidence for persistent structural disease desiring ongoing aggressive management should have cross-sectional imaging of the brain, neck (and/or ultrasound), chest, abdomen, and pelvis at 1- to 3-month intervals for 6-12 months, then at 4- to 6-month intervals for a minimum of one additional year. (S-L) Î 18 F-FDG PET scanning should be considered about 3-6 months after initial therapy in patients with no clinical evidence of disease to identify small volume disease that may require a change in the management plan. Furthermore, 18 F-FDG PET scanning should also be considered at 3- to 6-month intervals in patients with persistent structural disease as a guide to the response to therapy and to identify new sites of disease that may necessitate a change in the management plan. (S-L) Î Neither serum thyroglobulin measurements nor RAI scanning or therapy are recommended in the initial management of ATC unless the anaplastic component represents a minor component of a more well- differentiated thyroid cancer. (S-L) Î After a 6- to 12-month follow-up period, patients without evidence of recurrent/progressive ATC should be considered for RAI therapy if the original tumor had well-differentiated thyroid cancer components. (S-L) Restaging of Patients with Persistent Metastatic Disease Î Patients with persistent structural disease following initial staging and therapy should have frequent cross-sectional imaging (at least every 1-3 months), which may include brain, neck, chest, abdomen, pelvis, and known sites of disease as clinically indicated to guide systemic and/or local therapy. (S-L) Î Patients with persistent structural disease following initial staging and therapy who wish to minimize additional therapy may undergo symptom-directed cross-sectional imaging. (S-L)

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