BACKGROUND: Medicare expenditures for high-cost diagnostic imaging have risen faster than those for total cancer care and have been targeted for potential cost reduction. We sought to determine recent and long-term patterns in high-cost diagnostic imaging use among elderly (aged ≥65 years) patients with stage IV cancer. METHODS: We identified claims within the Surveillance, Epidemiology, and End Results (SEER)-Medicare database with computed tomography, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans between January 1994 and December 2009 for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer between January 1995 and December 2006 (N = 100,594 patients). The proportion of these patients imaged and rate of imaging per-patient per-month of survival were calculated for each phase of care in patients diagnosed between January 2002 and December 2006 (N = 55,253 patients). Logistic regression was used to estimate trends in imaging use in stage IV patients diagnosed between January 1995 and December 2006, which were compared with trends in imaging use in early-stage (stages I and II) patients with the same tumor types during the same period (N = 192,429 patients). RESULTS: Among the stage IV patients diagnosed between January 2002 and December 2006, 95.9% underwent a high-cost diagnostic imaging procedure, with a mean number of 9.79 (SD = 9.77) scans per patient and 1.38 (SD = 1.24) scans per-patient per-month of survival. After the diagnostic phase, 75.3% were scanned again; 34.3% of patients were scanned in the last month of life. Between January 1995 and December 2006, the proportion of stage IV cancer patients imaged increased (relative increase = 4.6%, 95% confidence interval [CI] = 3.7% to 5.6%), and the proportion of early-stage cancer patients imaged decreased (relative decrease = -2.5%, 95% CI = -3.2% to -1.9%). CONCLUSIONS: Diagnostic imaging is used frequently in patients with stage IV disease, and its use increased more rapidly over the decade of study than that in patients with early-stage disease.
BACKGROUND: Medicare expenditures for high-cost diagnostic imaging have risen faster than those for total cancer care and have been targeted for potential cost reduction. We sought to determine recent and long-term patterns in high-cost diagnostic imaging use among elderly (aged ≥65 years) patients with stage IV cancer. METHODS: We identified claims within the Surveillance, Epidemiology, and End Results (SEER)-Medicare database with computed tomography, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans between January 1994 and December 2009 for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer between January 1995 and December 2006 (N = 100,594 patients). The proportion of these patients imaged and rate of imaging per-patient per-month of survival were calculated for each phase of care in patients diagnosed between January 2002 and December 2006 (N = 55,253 patients). Logistic regression was used to estimate trends in imaging use in stage IV patients diagnosed between January 1995 and December 2006, which were compared with trends in imaging use in early-stage (stages I and II) patients with the same tumor types during the same period (N = 192,429 patients). RESULTS: Among the stage IV patients diagnosed between January 2002 and December 2006, 95.9% underwent a high-cost diagnostic imaging procedure, with a mean number of 9.79 (SD = 9.77) scans per patient and 1.38 (SD = 1.24) scans per-patient per-month of survival. After the diagnostic phase, 75.3% were scanned again; 34.3% of patients were scanned in the last month of life. Between January 1995 and December 2006, the proportion of stage IV cancerpatients imaged increased (relative increase = 4.6%, 95% confidence interval [CI] = 3.7% to 5.6%), and the proportion of early-stage cancerpatients imaged decreased (relative decrease = -2.5%, 95% CI = -3.2% to -1.9%). CONCLUSIONS: Diagnostic imaging is used frequently in patients with stage IV disease, and its use increased more rapidly over the decade of study than that in patients with early-stage disease.
Authors: David G Pfister; David H Johnson; Christopher G Azzoli; William Sause; Thomas J Smith; Sherman Baker; Jemi Olak; Diane Stover; John R Strawn; Andrew T Turrisi; Mark R Somerfield Journal: J Clin Oncol Date: 2003-12-22 Impact factor: 44.544
Authors: Angela B Mariotto; K Robin Yabroff; Yongwu Shao; Eric J Feuer; Martin L Brown Journal: J Natl Cancer Inst Date: 2011-01-12 Impact factor: 13.506
Authors: Karynsa Cetin; Jennifer L Beebe-Dimmer; Jon P Fryzek; Richard Markus; Michael A Carducci Journal: Urology Date: 2009-12-06 Impact factor: 2.649
Authors: Craig C Earle; Bridget A Neville; Mary Beth Landrum; John Z Ayanian; Susan D Block; Jane C Weeks Journal: J Clin Oncol Date: 2004-01-15 Impact factor: 44.544
Authors: E Massarelli; F Andre; D D Liu; J J Lee; M Wolf; A Fandi; J Ochs; T Le Chevalier; F Fossella; R S Herbst Journal: Lung Cancer Date: 2003-01 Impact factor: 5.705
Authors: Ezekiel J Emanuel; Yinong Young-Xu; Norman G Levinsky; Gail Gazelle; Olga Saynina; Arlene S Ash Journal: Ann Intern Med Date: 2003-04-15 Impact factor: 25.391
Authors: Melissa K Accordino; Jason D Wright; Sowmya Vasan; Alfred I Neugut; Grace C Hillyer; Jim C Hu; Dawn L Hershman Journal: J Clin Oncol Date: 2016-05-09 Impact factor: 44.544
Authors: Joshua M Bauml; Andrea Troxel; C Neill Epperson; Roger B Cohen; Kathryn Schmitz; Carrie Stricker; Lawrence N Shulman; Angela Bradbury; Jun J Mao; Corey J Langer Journal: Lung Cancer Date: 2016-08-16 Impact factor: 5.705
Authors: J Michael McWilliams; Jesse B Dalton; Mary Beth Landrum; Austin B Frakt; Steven D Pizer; Nancy L Keating Journal: Ann Intern Med Date: 2014-12-02 Impact factor: 25.391
Authors: Kesav Raghavan; Timothy P Copeland; Michael Rabow; Maya Ladenheim; Angela Marks; Steven Z Pantilat; David O'Riordan; David Seidenwurm; Benjamin Franc Journal: BMJ Support Palliat Care Date: 2019-03-01 Impact factor: 3.568
Authors: Leah M Backhus; Farhood Farjah; Thomas K Varghese; Aaron M Cheng; Xiao-Hua Zhou; Douglas E Wood; Larry Kessler; Steven B Zeliadt Journal: J Clin Oncol Date: 2014-09-22 Impact factor: 44.544
Authors: Sema Sezgin Goksu; Seyda Gunduz; Dilek Unal; Mukremin Uysal; Deniz Arslan; Ali M Tatlı; Hakan Bozcuk; Mustafa Ozdogan; Hasan S Coskun Journal: BMC Palliat Care Date: 2014-11-19 Impact factor: 3.234