A Sticky Wicket No Doubt – study suggests unnecessary screening of advanced cancer patients being done.

This post was authored by Brian Nash and posted to The Eye Opener on October 13th, 2010.

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An article published today in JAMA reports a case-control study regarding the efficacy of continued surveillance through screening of patients with advanced cancer. The conclusion of the researchers: “A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.”

The study, according to a synopsis provided in an email alert we received from Physician’s First Watch, “used the Surveillance, Epidemiology and End Results (SEER) cancer registry to identify roughly 88,000 patients aged 65 or older diagnosed with advanced lung, colorectal, breast, gastroesophageal, or pancreatic cancer (median survival after diagnosis, 4–16 months). The researchers then examined whether patients were screened for other cancers.”

What the synopsis didn’t mention was that these were “fee-for-service Medicare enrollees.” For those of you having to deal with Medicare issues (which we do all the time in light of the super lien issues affecting our clients who receive Medicare and Medicaid benefits), one wonders just how big a role this “payor” issue played in the reason for the study and its conclusion.

It is common knowledge that Medicare’s solvency remains a major issue in our politically charged financial landscape. On August 5, 2010, U.S. Department of HHS Secretary, Kathleen Sebelius, joined Treasury Secretary Tim Geithner, Hilda Solis, Secretary of Labor, and the Social Security Administrator, Michael Astrue (the latter being also Trustees of the Social Security and Medicare Trust) in releasing the 2010 Annual Social Security and Medicare Trustees Report. In essence, they announced that the solvency of the Trust Fund would be extended by 12 years until 2029.” A “Fact Sheet” has been published by the Centers for Medicare and Medicaid Services (CMS) for those interested in reviewing the substance of the report. While the actual statistical findings are readily available in the JAMA abstract, here is a more concise version of the study’s findings:

  • Overall, cancer patients were screened between one third and one half as often as cancer-free controls.
  • Roughly 9% of women with cancer underwent mammography, and 6% had Pap tests.
  • Some 15% of men with cancer underwent prostate-specific antigen testing.
  • About 2% of cancer patients had lower GI endoscopy.
  • Putting aside the issue of financial expediency, how do you feel about avoidance of screening for “other cancer” in such patients? Is it worth the cost? Not worth the cost? Should we restrict such testing to avoid its apparent financial impact on our Medicare system?

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