Stage IV Cancer Patients Undergo More Diagnostic Imaging

Most Medicare patients with stage IV breast, colorectal, lung, or prostate cancer undergo more high-cost imaging procedures while receiving treatment than do those with early stage disease, reported researchers in a study published today in the Journal of the National Cancer Institute.

As the use of diagnostic imaging increases, so do the costs. Researchers in Massachusetts and Wisconsin undertook a study to determine the usage of high-cost imaging in patients with cancer who are near the end of life. They examined claims with the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1994 and 2009 for reports of CT scans, MR images, PET scans, and nuclear medicine scans performed on patients with stage IV breast, colorectal, lung, or prostate cancer. These were compared with patients who had early stages of the same cancer types.

The findings showed a significant difference between imaging performed on stage IV patients in 1995 and in 2006. Between January 2002 and December 2006, 95.9 percent underwent a high-cost diagnostic imaging procedure, 75.3 percent were scanned again after diagnosis, and 34.3 percent were scanned during their last month of life.

The researchers found that between 1995 and 2006, the proportion of patients in this group who were imaged had a relative increase of 4.6 percent, while the proportion of patients imaged in the earlier stages of cancer actually had a relative decrease of 2.5 percent.

Researchers don’t know why there is this increase in scans, but suggested that it could be due to the lack of guidelines for imaging in patients with advanced cancers. This is an important issue, researchers said.

“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 wrote. “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.”

In an accompanying editorial, Robin Yabroff, MD, and Joan Warren, MD, of the Health Services and Economics Branch at the National Cancer Institute, stated that guidelines are needed. “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."