Refining radiologists’ imaging practices for incidental prostate cancer reduces overtreatment, costs
Refining imaging practices for incidentally detected prostate cancers can reduce inappropriate treatment and unnecessary healthcare costs, according to research published in Cancer Reports.
National Comprehensive Cancer Network rules for staging these cancers have been widely used and accepted since 1996, but improper imaging remains a problem, researchers explained June 17.
Looking over national Medicare data, the team found two-thirds of high-risk patients with incidentally spotted cancers received appropriate imaging. At the same time, 45% of low-risk cases underwent imaging against NCCN guidance.
Using this information, the authors created a simulation model to assess how more consistent utilization may alter the landscape. When focusing on imaging high-risk men, those qualified for exams dropped from 53% to 38%, and average per-person spending fell from $236 to $157.
For many individuals, imaging is key to better treatment. For others, however—such as lower-risk groups—it can cause distress and contribute to ballooning healthcare spending.
“While imaging may yield useful additional information for some patients, for many imaging has a low probability of influencing treatment choices, and therefore, its harms outweigh its benefits,” Aaron N. Winn, PhD, with the Medical College of Wisconsin’s Cancer Center and co-authors noted. “These findings highlight an opportunity within the healthcare system to reduce unnecessary costs and overtreatment through guideline adherence,” they added later.
The microsimulation model used in this study was based on incidental prostate cancer cases gathered from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program. That database includes men over 65 diagnosed between 2004 and 2009.
Winn and colleagues did note their model found only a modest reduction in costs and any intervention to enhance guideline-adherent imaging should be relatively affordable. Prostate Cancer Imaging Stewardship Intervention efforts targeting clinician behavior may be useful, they explained.
Finally, the group noted their analysis may downplay the role of overimaging in today’s world.
“In current clinical practice, the imaging recommendations and guidelines remain largely unchanged,” the authors added. “There are now newer, more expensive technologies for staging, and it is possible that we will be underestimating the importance and value of guideline-concordant imaging in the field today.”
Read more from the study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.