The costs of diagnostic imaging have increased more than the overall costs of cancer care, making diagnostic imaging the fastest-growing part of Medicare-reimbursed services, the researchers noted. Medicare is the U.S. government-funded health insurance program for people over 65 and certain other patients.
They added that cancer care costs are highest during the last year of life, but little is known about the use of high-cost imaging tests in cancer patients during their final year.
In this study, the researchers examined data on the use of CT, MRI, PET and nuclear medicine scans for Medicare patients with late-stage (stage 4) breast, colon, lung or prostate cancer between 1995 and 2006. Stage 4 cancer means the cancer has spread throughout the body.
The analysis revealed that most of the patients underwent imaging procedures during the course of their care, and that the use of imaging in late-stage cancer patients increased between 1995 and 2006.
The study was published July 30 in the Journal of the National Cancer Institute.
The increasing use of imaging in late-stage cancer patients may be due to a lack of guidelines in this area or the use of imaging to help doctors manage symptoms, detect disease progression and assess the effects of treatment, said Dr. Yue-Yung Hu and colleagues at the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and the University of Wisconsin.
While imaging often leads to appropriate measures to ease dying patients' suffering, it can also distract them from focusing on achievable end-of-life goals, cause them to spend more of their remaining time in medical care settings, and provoke anxiety, the researchers said.
Determining the most appropriate care for patients with late-stage cancer is complex, Drs. Robin Yabroff and Joan Warren, of the Health Services and Economics Branch at the U.S. National Cancer Institute, noted in an accompanying editorial.
"Physicians tend to overestimate survival for terminally ill cancer patients, which may influence their treatment and related imaging recommendations," they wrote in a journal news release. "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."
More information
The American Cancer Society offers advice for cancer patients nearing the end of life.
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