Popular media may be kicking up inappropriate PET use
The question of appropriate use of advanced nuclear medicine procedures is more salient than it has ever been, with overall health cost under government scrutiny and imaging eyed in particular due to increasing procedure numbers. Some experts are pointing to non-medical news sites and other media as a culprit in patient demand for potentially inappropriate PET use, according to a study published Feb. 18 in Cancer Epidemiology, Biomarkers & Prevention.
The cost of medical imaging per patient in the U.S. has grown at a clip of three or four times that of general healthcare costs, notes the report. Andy S. L. Tan, PhD, a public health physician specializing in healthcare communication research at the University of Pennsylvania in Philadelphia, and colleagues obtained three years' worth of self-reported patient data regarding PET follow-up after treatment for non-metastatic prostate, breast or colorectal cancer. A survey of information for 944 patients diagnosed in 2005 was included in the study. According to the three-year longitudinal data, adjusted with logistic regression analysis, 11 percent of these patients reported undergoing at least one PET exam within a 12-month period after their diagnosis.
“Cancer-related information from lay interpersonal and media sources was found to be a strong predictor of PET overuse, even after adjusting for confounders,” Tan told Molecular Imaging. “This suggests that these information sources may contain inaccurate information about the appropriateness of PET for cancer surveillance. For example, promotional materials may overstate the benefits of PET for cancer surveillance even though it is not recommended for most cancer patients. The implication from this finding is that there is a greater need to provide cancer patients with accurate and reliable facts about what procedures are appropriate for their cancer follow-up.”
While information-seeking from nonmedical sources on the part of patients increased the odds of higher subsequent PET usage, communicating with medical providers was not. There was also some suggestion that patient demand had an influence on healthcare providers ordering PET scans despite guidelines that do not recommend PET for most primary malignancies, except in special cases—for instance, patients with sarcoma or cervical cancer.
The study suggests that inappropriate use of PET may lead to unnecessary radiation exposure, anxiety due to false readings either positive or negative and additional expense.
“We recommend additional research in the following three areas: First, there needs to be closer monitoring of trends in the usage of PET for routine surveillance among cancer survivors nationally; second, an analysis of promotional materials from PET imaging facilities would be necessary to assess whether they are providing patients with accurate information about the role of PET imaging for cancer surveillance; third, future studies should examine whether and how promotional materials from PET imaging facilities are influencing patients’ (and their physicians’) decisions about getting PET scans for routine surveillance,” added Tan.