High-cost Imaging Used Frequently in Elderly with Stage IV Cancer

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Patients with stage IV breast, colorectal, lung, and prostate cancers undergo frequent high-cost imaging procedures throughout the continuum of their care, and rates of imaging have steadily increased, according to an analysis of claims from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. These imaging procedures included computed tomography (CT), magnetic resonance imaging (MRI), positron-emission tomography (PET), and nuclear medicine (NM) scans.

“Among the stage IV patients diagnosed between January 2002 and December 2006, 95.9% underwent a high-cost diagnostic imaging procedure, with a mean number of 9.79 (SD = 9.77) scans per patient and 1.38 (SD = 1.24) scans per-patient per-month of survival,” the researchers reported. “After the diagnostic phase, 75.3% were scanned again; 34.3% of patients were scanned in the last month of life.” CTs were the most commonly used imaging procedures, with 93.7% of patients receiving at least one CT and most receiving several CTs.

“Currently, few guidelines attempt to define the appropriate role of imaging in patients with advanced disease, and those that do largely reflect expert opinion. Routine use of imaging is recommended only in patients with colorectal cancer metastatic to the liver or lung; in such patients, the National Comprehensive Cancer Network (NCCN) advises a CT or MRI every 2 months after initiating chemotherapy to reevaluate for resectability, followed by every 2 to 3 months during palliative chemotherapy if conversion is not accomplished. In stage IV breast, lung, and prostate cancer, the guidelines either do not specify parameters for testing or advocate use only as indicated by symptomatology,” the investigators noted.

“Despite these recommendations, we found that the vast majority of patients with breast, lung, and prostate cancer undergo imaging after diagnosis at rates similar to (or higher than) that of the colorectal subset,” the authors continued. “Such discretionary decision-making, ie, the ‘gray’ area where recommendations are equivocal or nonexistent, is known to drive higher healthcare spending.” ■

Hu Y-Y, et al: J Natl Cancer Inst 104:1165-1173, 2012.




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