High-cost imaging increasingly used for stage IV cancer patients

By Lynda Williams, Senior MedWire Reporter

High-cost diagnostic imaging was increasingly used for elderly patients with stage IV cancer of the breast, lung, and prostate, and colorectal cancer in the USA, research demonstrates.

The study, published in the Journal of the National Cancer Institute, showed that the use of computed tomography, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans in this population increased by a relative 4.6%, whereas use in stage I-II patients fell by 2.5% over the same period.

The team calculated the proportion of 55,253 US patients diagnosed with stage IV cancer who underwent imaging between 2002 and 2006, and comparing the use of imaging for 192,429 stage I and II cancer patients.

Overall, 95.9% of stage IV patients underwent a high-cost imaging procedure during diagnosis, at an average of 9.79 scans per patient and 1.38 scans per patient per month of survival. The majority (75.3%) of patients underwent further scans, with 34.3% screened in the last month of life.

"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," explain Caprice Greenberg (University of Wisconsin Hospitals and Clinics, Madison, USA) and co-authors.

However, they note that evidence-based guidelines are lacking on the optimal use of imaging in advanced cancer patients, with such imaging only recommended for colorectal cancer patients undergoing palliative chemotherapy for metastasis to the lung or liver.

This has led to discretionary use for other advanced cancers, say the researchers, recognizing that "gray areas" can drive up healthcare expenditure. By contrast, national guidelines on the use of surveillance imaging for early-stage cancer patients have reduced use.

The team concludes: "As our approach to their care evolves, it will be important to define the role of high-cost imaging to ensure that the maximum value, in terms of both societal resources and patient quality of life, is achieved."

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