Diagnostic imaging increases among stage IV cancer patients on Medicare

July 30, 2012

The use of diagnostic imaging in Medicare patients with stage IV cancer has increased faster than among those with early-stage (stages I and II) disease, according to a study published July 30 in the Journal of the National Cancer Institute.

The costs of diagnostic imaging have increased more rapidly than the overall costs of , making diagnostic imaging the fastest-growing division of Medicare-reimbursed services. The net costs of cancer care are the highest in the last year of life; yet little is known about the use of high-cost imaging in cancer patients during the last year of life.

In order to determine the usage of high-cost imaging in cancer patients at the end of life, Yue-Yung Hu, M.D., M.P.H. and colleagues in the Center for Outcomes and Policy Research at Dana-Farber Cancer Institute, the Center for Surgery and Public Health at Brigham and Women's Hospital, and Wisconsin Research Program at the University of Wisconsin, looked at claims within the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1994 and 2009 for computed tomography, , , and nuclear medicine scans for patients diagnosed with stage IV breast, colorectal, lung, or between 1995-2006. The rate of imaging per-patient per-month of survival was determined for each phase of care. For reference, trends in imaging use in early-stage patients with the same tumor types during the same time period were also considered.

The researchers found that most patients with stage IV breast, colorectal, lung, and prostate cancer undergo high-cost imaging procedures throughout the course of their care and that the usage of imaging has steadily increased between 1995 and 2006. The increase may reflect a lack of guidelines in this area or the use of imaging to guide symptom management, detect disease progression and assess treatment effect. "Because scans help clinicians determine whether a change in (or cessation of) treatment is indicated, the expanding use of advanced imaging in stage IV disease is likely a manifestation of the increasing number and types of treatment options available to these patients," the authors write. "Imaging, although it often leads to (appropriate) palliative measures, may also distract patients from focusing on achievable end-of-life goals, require them to spend more of their limited time in medical care settings and/or provoke anxiety." The authors point out the importance of examining such patient-centered outcomes in future research to define the role of advance imaging in Stage IV solid tumors.

In an accompanying editorial, Drs. Robin Yabroff and Joan Warren, of the Health Services and Economics Branch at the , feel that assessing the appropriateness of care for patients with stage IV disease is complex. "Physicians tend to overestimate survival for terminally ill , which may influence their treatment and related imaging recommendations," the editorialists write. "Development of practice guidelines for advanced imaging in patients with stage IV disease, with explicit statements about the state of evidence will be critical, particularly for care outside of the window surrounding patient diagnosis."

Explore further: Have no fear: Most cases of thyroid cancer do not affect survival

Related Stories

Have no fear: Most cases of thyroid cancer do not affect survival

June 11, 2012
Research presented at the Society of Nuclear Medicine's 59th Annual Meeting reveals that patients with differentiated thyroid cancer live as long as people in perfect health, unless they are in the minority and have reached ...

Breast cancer patients face increasing number of imaging visits before surgery

December 9, 2011
Breast cancer patients frequently undergo imaging like mammograms or ultrasounds between their first breast cancer-related doctor visit and surgery to remove the tumor. Evaluations of these scans help physicians understand ...

Recommended for you

Researchers discover specific tumor environment that triggers cells to metastasize

November 21, 2017
A team of bioengineers and bioinformaticians at the University of California San Diego have discovered how the environment surrounding a tumor can trigger metastatic behavior in cancer cells. Specifically, when tumor cells ...

New study points the way to therapy for rare cancer that targets the young

November 21, 2017
After years of rigorous research, a team of scientists has identified the genetic engine that drives a rare form of liver cancer. The findings offer prime targets for drugs to treat the usually lethal disease, fibrolamellar ...

Clinical trial suggests new cell therapy for relapsed leukemia patients

November 20, 2017
A significant proportion of children and young adults with treatment-resistant B-cell leukemia who participated in a small study achieved remission with the help of a new form of gene therapy, according to researchers at ...

Cell-weighing method could help doctors choose cancer drugs

November 20, 2017
Doctors have many drugs available to treat multiple myeloma, a type of blood cancer. However, there is no way to predict, by genetic markers or other means, how a patient will respond to a particular drug. This can lead to ...

Researchers discover a new target for 'triple-negative' breast cancer

November 20, 2017
So-called "triple-negative" breast cancer is a particularly aggressive and difficult-to-treat form. It accounts for only about 10 percent of breast cancer cases, but is responsible for about 25 percent of breast cancer fatalities.

Study reveals new mechanism used by cancer cells to disarm attacking immune cells

November 20, 2017
A new study by researchers at The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute (OSUCCC - James) identifies a substance released by pancreatic cancer cells that protects ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.