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Advanced Cancer Patients Get Unneeded Tests for More Malignancy

Patients with advanced incurable cancer are still routinely screened for additional types of malignancies, causing anxiety and no benefit for most, researchers said.

About 9 percent of women in the study age 65 and older, who were expected to live less than two years because of advanced cancer, still received at least one mammogram, the study found. About 15 percent of men with advanced disease also had prostate cancer screenings, according to the research published today in the Journal of the American Medical Association found.

The researchers said they conducted the study to improve care for patients and to reduce wasteful spending in Medicare, the U.S. health program for the elderly and disabled. Eliminating routine cancer screenings for people who already have advanced tumors may avoid unnecessary biopsies and psychological distress, the authors said.

“The benefits and risks of cancer screening are very changed in the face of limited life expectancy,” said the study’s lead study, Camelia Sima, an assistant attending biostatistician at Memorial Sloan-Kettering Cancer Center in New York. “What we think we see here is the manifestation of cancer screening on auto pilot,” she said in an Oct. 8 telephone interview

Researchers in the study looked at 87,736 Medicare recipients who had been diagnosed with advanced cancers of the lungs, colon, pancreas, esophagus or breast from 1998 to 2005. They were followed through December 2007 or until their deaths.

Survival Times

The average age of the cancer patients was 75. Survival ranged from an average of 4.3 months for those with pancreatic cancer to an average of 16.2 months for those with breast cancer. The researchers compared them to a group of 87,307 similar Medicare recipients who didn’t have cancer.

The researchers looked at the use of mammography, Pap tests and prostate and colon screenings in both groups.

The study showed that 8.9 percent of women who had advanced cancer received at least one mammography screening and 5.8 percent had a Pap test compared with 22 percent and 12.5 percent for the group without cancer. Among the men, 15 percent who had advanced malignancy received a prostate cancer screening test versus 27.2 percent of those who didn’t have cancer.

The results revealed that the advanced malignancy groups underwent screening for cancers at rates that were 35 percent to 55 percent that of patients who weren’t ill. This means one in three or, in some cases, one in two continue to get the cancer screening even when their limited life expectancy meant it wouldn’t help them, Sima said.

Many doctors are trained to enforce routine screening in patients because people don’t always get tests when they should, said a second author of the research, Katherine Panageas, associate attending biostatistician at Memorial Sloan-Kettering. That recommendation shouldn’t always apply to older advanced cancer patients who may not live long enough to get any benefit.

“In this particular population, we’re seeing that there’s evidence of over-utilization,” Panageas said in an Oct. 8 telephone interview.

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