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 cancer care, 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 Surgical Outcomes 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, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer 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.
In an accompanying editorial, Drs. Robin Yabroff and Joan Warren, of the Health Services and Economics Branch at the National Cancer Institute, feel that assessing the appropriateness of care for patients with stage IV disease is complex. "Physicians tend to overestimate survival for terminally ill cancer patients, 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."