Inertia in Medicine Sometimes Defies Common Sense ─ Unnecessary Cancer Screenings in Advanced Cancer Patients

© 2010 Peter Free

 

13 October 2010

 

Unnecessary cancer screenings in advanced cancer patients are a small indicator of what is expensively wrong with American health care

 

The Journal of the American Medical Association just reported that a surprising number of cancer screenings are done in patients with already advanced cancer.

 

In other words, some people are being screened for cancer(s), when they are already terminally ill.

 

Camelia Sima et al. matched 87,736 Medicare patients with advanced cancer against 87,307 Medicare patients without cancer.

 

The researchers’ most extreme findings were for the following group:

 

Screening was more frequent among patients with a recent history of screening (16.2% [95% CI, 15.4%-16.9%] of these patients had mammography, 14.7% [95% CI, 13.7%-15.6%] had a Papanicolaou test, 23.3% [95% CI, 22.6%-24.0%] had a PSA test, and 6.1% [95% CI, 5.2%-7.0%] had lower GI endoscopy).

 

Conclusion  A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.

 

© 2010 Camelia S. Sima, Katherine S. Panageas & Deborah Schrag, Cancer Screening Among Patients With Advanced Cancer , JAMA 304(14):1584-1591 (13 October 2010).

 

How is that for inefficient and expensive health care delivery?

 

A less polite summation

 

If the findings are accurate, screening practices like these are medically and financially irresponsible enough to legitimate inquiry into why they are occurring with noticeable frequency.

 

Explanatory hypotheses include (i) greed, (ii) reluctance to have “terminally ill” conversations with patients, and (iii) poor communication between medical providers.