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Inappropriate use of medical imaging may be more widespread than previously thought

ASCO 2011 Genitourinary Cancers Symposium

ORLANDO — More than one-third of men at low risk for prostate cancer underwent unnecessary medical imaging, whereas less than two-thirds of men at high risk received an imaging test, according to findings presented here.

Sandip M. Prasad, MD, of the University of Chicago Medical Center, and colleagues conducted a study to characterize trends in radiographic imaging, including bone scan, CT and MRI procedures, in 30,183 men with newly diagnosed prostate cancer.

Unnecessary imaging was used for staging in 36% of men with low risk and 49% of men with intermediate risk. Only 61% of men in the high-risk group received any imaging test before treatment.

Being older than 75 years, black, wealthier and living in rural regions were associated with use of medical imaging. Men who underwent cryotherapy, proton beam therapy and radiation/brachytherapy also were more likely to receive medical imaging.

Educated men and those who chose watchful waiting were less likely to receive medical imaging.

Charlson score and marital status were not linked to medical imaging use.

“There is widespread overutilization of staging in low- and intermediate-risk patients, while a worrisome number of men at high risk undergo treatment without appropriate diagnostic imaging,” the researchers wrote. “Physicians may be prescribing costly and unnecessary tests with associated harmful radiation in over one-third of patients, while forgoing the recommended metastatic workup in almost 40% of high-risk patients prior to treatment.”

Patients were identified during 2004-2005 using SEER-Medicare linked data.

For more information:

  • Prasad SM. #120. Presented at: 2011 Genitourinary Cancers Symposium; Feb. 15-19, 2011; Orlando, Fla.

Disclosure: Dr. Prasad reports no relevant financial disclosures.

PERSPECTIVE

This study raises the bigger question of how often physicians are following published guidelines; in this case, for the use of medical imaging. We want to treat patients in a way that level one evidence dictates, but unfortunately, this is not always the case. We see it not only in prostate cancer but in other genitourinary cancers, as well.

This is something that plagues our field. We need to judiciously use staging by following what is suggested and recommended in the literature. Hopefully, as we have more systems based in medicine, we can make better use of our dollars.

There are multiple studies showing that adherence to staging recommendations is incomplete in the US.

One other point is that patients need to be more aware of the numbers regarding specific scans. If they knew the data and had the resources to find out which tests will be beneficial and which would not in their particular circumstances, they may feel more comfortable not receiving an MRI or a scan. Physicians need to dispel the feeling patients have that they always need these procedures. It is incumbent upon the treating physician to provide the data so the patient can understand why the recommendations are what they are.

For example, if we can tell a patient the exact dose of radiation that they will receive in that particular CT scan, and then explain that excessive radiation exposure over the course of a lifetime can increase the risk for other malignancies, now the conversation changes.

– Dean Bajorin, MD
Professor of medicine at Memorial Sloan-Kettering Cancer Center

Disclosure: Dr. Bajorin reports no relevant financial disclosures.

Twitter Follow HemOncToday.com on Twitter.

ASCO 2011 Genitourinary Cancers Symposium

ORLANDO — More than one-third of men at low risk for prostate cancer underwent unnecessary medical imaging, whereas less than two-thirds of men at high risk received an imaging test, according to findings presented here.

Sandip M. Prasad, MD, of the University of Chicago Medical Center, and colleagues conducted a study to characterize trends in radiographic imaging, including bone scan, CT and MRI procedures, in 30,183 men with newly diagnosed prostate cancer.

Unnecessary imaging was used for staging in 36% of men with low risk and 49% of men with intermediate risk. Only 61% of men in the high-risk group received any imaging test before treatment.

Being older than 75 years, black, wealthier and living in rural regions were associated with use of medical imaging. Men who underwent cryotherapy, proton beam therapy and radiation/brachytherapy also were more likely to receive medical imaging.

Educated men and those who chose watchful waiting were less likely to receive medical imaging.

Charlson score and marital status were not linked to medical imaging use.

“There is widespread overutilization of staging in low- and intermediate-risk patients, while a worrisome number of men at high risk undergo treatment without appropriate diagnostic imaging,” the researchers wrote. “Physicians may be prescribing costly and unnecessary tests with associated harmful radiation in over one-third of patients, while forgoing the recommended metastatic workup in almost 40% of high-risk patients prior to treatment.”

Patients were identified during 2004-2005 using SEER-Medicare linked data.

For more information:

  • Prasad SM. #120. Presented at: 2011 Genitourinary Cancers Symposium; Feb. 15-19, 2011; Orlando, Fla.

Disclosure: Dr. Prasad reports no relevant financial disclosures.

PERSPECTIVE

This study raises the bigger question of how often physicians are following published guidelines; in this case, for the use of medical imaging. We want to treat patients in a way that level one evidence dictates, but unfortunately, this is not always the case. We see it not only in prostate cancer but in other genitourinary cancers, as well.

This is something that plagues our field. We need to judiciously use staging by following what is suggested and recommended in the literature. Hopefully, as we have more systems based in medicine, we can make better use of our dollars.

There are multiple studies showing that adherence to staging recommendations is incomplete in the US.

One other point is that patients need to be more aware of the numbers regarding specific scans. If they knew the data and had the resources to find out which tests will be beneficial and which would not in their particular circumstances, they may feel more comfortable not receiving an MRI or a scan. Physicians need to dispel the feeling patients have that they always need these procedures. It is incumbent upon the treating physician to provide the data so the patient can understand why the recommendations are what they are.

For example, if we can tell a patient the exact dose of radiation that they will receive in that particular CT scan, and then explain that excessive radiation exposure over the course of a lifetime can increase the risk for other malignancies, now the conversation changes.

– Dean Bajorin, MD
Professor of medicine at Memorial Sloan-Kettering Cancer Center

Disclosure: Dr. Bajorin reports no relevant financial disclosures.

Twitter Follow HemOncToday.com on Twitter.

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