James S Goodwin1,2,3, Kristin Sheffield4,5,6, Shuang Li7, Alai Tan8,7,4,9. 1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. jsgoodwi@utmb.edu. 2. Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA. jsgoodwi@utmb.edu. 3. Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA. jsgoodwi@utmb.edu. 4. Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA. 5. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA. 6. Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, 46285, USA. 7. Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA. 8. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. 9. Ohio State University School of Nursing, 1582 Neil Ave, Columbus, OH, 43210, USA.
Abstract
BACKGROUND: Obtaining cancer screening on patients with limited life expectancy has been proposed as a measure for low quality care for primary care physicians (PCPs). However, administrative data may underestimate life expectancy in patients who undergo screening. OBJECTIVE: To determine the association between receipt of screening mammography or PSA and overall survival. DESIGN: Retrospective cohort study from 1/1/1999 to 12/31/2012. Receipt of screening was assessed for 2001-2002 and survival from 1/1/2003 to 12/31/2012. Life expectancy was estimated as of 1/1/03 using a validated algorithm, and was compared to actual survival for men and women, stratified by receipt of cancer screening. PARTICIPANTS: A 5 % sample of Medicare beneficiaries aged 69-90 years as of 1/1/2003 (n = 906,723). INTERVENTIONS: Receipt of screening mammography in 2001-2002 for women, or a screening PSA test in 2002 for men. MAIN MEASURES: Survival from 1/1/2003 through 12/31/2012. KEY RESULTS: Subjects were stratified by life expectancy based on age and comorbidity. Within each stratum, the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men. In a Cox model, non-receipt of screening in women had an impact on survival (HR = 1.52; 95 % CI = 1.51, 1.54) similar in magnitude to a diagnosis of complicated diabetes or heart failure, and was comparable to uncomplicated diabetes or liver disease in men (HR = 1.23; 1.22, 1.25). CONCLUSIONS: Receipt of cancer screening is a powerful marker of health status that is not captured by comorbidity measures in administrative data. Because life expectancy algorithms using administrative data underestimate the life expectancy of patients who undergo screening, they can overestimate the problem of cancer screening in patients with limited life expectancy.
BACKGROUND: Obtaining cancer screening on patients with limited life expectancy has been proposed as a measure for low quality care for primary care physicians (PCPs). However, administrative data may underestimate life expectancy in patients who undergo screening. OBJECTIVE: To determine the association between receipt of screening mammography or PSA and overall survival. DESIGN: Retrospective cohort study from 1/1/1999 to 12/31/2012. Receipt of screening was assessed for 2001-2002 and survival from 1/1/2003 to 12/31/2012. Life expectancy was estimated as of 1/1/03 using a validated algorithm, and was compared to actual survival for men and women, stratified by receipt of cancer screening. PARTICIPANTS: A 5 % sample of Medicare beneficiaries aged 69-90 years as of 1/1/2003 (n = 906,723). INTERVENTIONS: Receipt of screening mammography in 2001-2002 for women, or a screening PSA test in 2002 for men. MAIN MEASURES: Survival from 1/1/2003 through 12/31/2012. KEY RESULTS: Subjects were stratified by life expectancy based on age and comorbidity. Within each stratum, the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men. In a Cox model, non-receipt of screening in women had an impact on survival (HR = 1.52; 95 % CI = 1.51, 1.54) similar in magnitude to a diagnosis of complicated diabetes or heart failure, and was comparable to uncomplicated diabetes or liver disease in men (HR = 1.23; 1.22, 1.25). CONCLUSIONS: Receipt of cancer screening is a powerful marker of health status that is not captured by comorbidity measures in administrative data. Because life expectancy algorithms using administrative data underestimate the life expectancy of patients who undergo screening, they can overestimate the problem of cancer screening in patients with limited life expectancy.
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