Unnecessary Cancer Screening For Elderly Patients Causes Harm: Studies
New research suggests that many elderly patients are receiving unnecessary cancer screening tests, which may negatively affect their health and overall quality of life.
Two studies were published on-line last week by the medical journal JAMA Internal Medicine, which both found excessive cancer screening rates among the elderly.
In one of the studies, researchers from University of North Carolina at Chapel Hill examined the cancer screening rates for individuals with different life expectancies. The second study was published by researchers from the Netherlands, which looked at what happens when Medicare patients get more intensive colonoscopy screening than recommended.
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The University of North Carolina study used data from the National Health Interview Survey from 2000 through 2010, examining data on 27,404 participants aged 65 and older. Researchers looked at the rates of prostate, breast, cervical, and colorectal cancer screening, comparing screening rates by their mortality.
Researchers determined that 31% to 55% of participants with very high mortality risks received recent cancer screening, with prostate cancer being the most common. They also found that screening was common in people with less than a five-year life expectancy, and that the amount of screening has been decreasing in recent years.
“A substantial portion of the US population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit,” the researchers concluded. “These results suggest that overscreening is common in both men and women, which not only increases health care expenditure but can lead to net patient harm.”
Researchers from the Netherlands looked at the effects of colorectal screening on quality-adjusted life-years (QALYs) and whether they increased or decreased for patients who were 65 and on Medicare who underwent the screening. They found that screening patients more than recommended, in intervals of every three to five years instead of the recommended decade between screenings, only led to a small reduction in colorectal cancer deaths and years of life gained. However, they found large increases in colonoscopy complication risks for overscreened patients.
The study determined that, overall, screening more than recommended resulted in a loss of QALYs and a net harm to patients. Even when the screening was beneficial it cost $711,000 per additional QALY gained.
“Screening Medicare beneficiaries more intensively than recommended is not only inefficient from a societal perspective; often it is also unfavorable for those being screened,” the researchers concluded. “This study provides evidence and a clear rationale for clinicians and poly makers to actively discourage this practice.”
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