US researchers revealed that many cancer patients with only a few years to live often continue to get routine mammograms or blood tests for prostate cancer even though they are not likely to live long enough to benefit from them. This not only wastes money but also exposes patients to unnecessary worry and distress.
Camelia Sima of Memorial Sloan-Kettering Cancer Center in New York and colleagues wrote in the Journal of the American Medical Association, “Patients may be subject to unnecessary risk due to subsequent testing, biopsies, and psychological distress.”
The team looked at data on 87,736 people 65 or older with advanced lung, colorectal, pancreatic and other cancers enrolled in Medicare since 1998 to 2005, the federal health insurance program for the elderly. They compared it with Medicare patients of the same age, sex and race who did not have cancer.
They found that nearly 9 percent of women diagnosed with an incurable cancer got a mammogram and 5.8 percent got a Pap test. That compared with 22 percent of healthy patients who got a mammogram and 12.5 percent who got a Pap test. Among men with advanced cancer, 15 percent got a PSA test compared with 27.2 percent of healthy patients.
They write that some people just automatically get routine screening tests. “Electronic medical records increasingly have the sophistication to track cancer stage at diagnosis and disease status and to link this to screening reminder systems,” they wrote. And Medicare could simply decide not to pay for cancer screening tests done on patients with less than two years to live, they said.
Dr. Therese Bevers of University of Texas M.D. Anderson Cancer Center an independent observer said that part of it is that sometimes doctors and cancer patients do not want to give up hope. “It’s not just about saving healthcare dollars. I’m just thinking about the patient. Do we need to be putting them through this if they are not going to benefit from it?” she said.
Medicare pays roughly $130 for a mammogram, $25 for a PSA test, $30 for a Pap test and from $300 to $700 for a colonoscopy.