Implementing a Rapid Response Pathway for Anaplastic Thyroid Cancer in a Universal Healthcare System.

[OBJECTIVE] To implement a multidisciplinary anaplastic thyroid cancer rapid response team (ARRT) pathway in a universal healthcare system and evaluate its impact on diagnostic and treatment timelines for patients with anaplastic thyroid cancer (ATC).

[METHODS] This quasi-experimental study was conducted at a tertiary care cancer center in Canada. We compared 26 consecutive adult patients with confirmed ATC: 11 patients in the pre-pathway period (January 2015-June 2020) and 15 in the post-pathway period (July 2020-July 2023). The ARRT pathway incorporated early identification of suspected cases, image-guided biopsies with rapid on-site cytology evaluation, expedited staging and molecular analysis, coordinated same-day multidisciplinary consultations, and early palliative care involvement. Outcomes included time from initial clinical suspicion to staging completion, multidisciplinary assessment, and treatment initiation.

[RESULTS] The ARRT pathway significantly reduced median time from initial suspicion to staging completion from 21 days (IQR: 12-45) to 6 days (IQR: 2-9) ( < 0.01), time to multidisciplinary assessment from 28 days (IQR: 14-71) to 8 days (IQR: 6-14) ( < 0.01), and time to treatment initiation from 29 days (IQR: 18-83) to 18 days (IQR: 14-21) ( = 0.035). Post-pathway patients demonstrated greater consistency in rapid molecular testing (100% vs. 54%,  < 0.01) and higher rates of R0/R1 resection (4/4 patients [100%] vs. 1/6 patients [17%],  < 0.01).

[CONCLUSION] The ARRT pathway reduced diagnostic and treatment delays for ATC patients within a universal healthcare system. This rapid response model demonstrates feasibility and effectiveness in improving care coordination for rare aggressive malignancies. The approach provides a replicable four-phase implementation framework for similar healthcare systems globally.

[LEVEL OF EVIDENCE] 3.