Healthcare costs are spiraling the world over. In order to limit unnecessary tests and procedures on patients, the American Board of Internal medicine (ABIM) started a
campaign called Choosing Wisely® to spur a discussion between patients and their doctors. As part of the campaign, the American Society of Clinical Oncology (One of the biggest cancer societies in the world) released a list of tests to better educate cancer patients and physicians to avoid useless expenditure. Though these guidelines are by American medical societies, they are applicable world over. These tests are expensive and can cost anywhere from Rs 5000 for a bone scan to Rs 13,000 for a CAT scan to as high as Rs 24,000 for a PET scan. Hence, it is important that these tests are only performed when indicated. Below is a summary of selected recommendations
1. Prostate cancer: It is not recommended to perform routine PET scans (a kind of scan that utilises glucose uptake to detect sites of cancer spread), CAT scans or bone scans in patients with prostate cancer who have disease diagnosed in early stages and who are at a very low risk of the cancer spreading to other areas of the body. In addition PSA (a common blood test which is done to find out if men have prostate cancer) is not recommended if the person does not have any symptoms and is not expected to live more than ten years.
2. Breast cancer patients who have been recently diagnosed: It is not recommended to perform PET scans, CAT scans and bone scans in patients diagnosed with stage 1 or 2 breast cancer. The only exception is if a patient has symptoms that points to distant spread of the disease (like headaches, bone pain, etc.).
3. Follow up for breast cancer patients after surgery for their cancer: A large number of patients with breast cancer are diagnosed early and cured with surgery (with or without chemotherapy and radiation). After completion of active treatment, patients should follow up with regular physical examination and mammograms. However, a number of these patients undergo blood tests (called tumor markers) or scans (like PET, CAT or bone scans) as part of their routine follow up that are not recommended.
4. Majority of the cancer patients who have finished their cancer treatment and are in follow up (with no evidence of cancer) do not need PET scans to follow them unless they have symptoms that the disease may be back or there is a high level of evidence that doing a PET scan will prolong their life.
These tests are often used in clinical practice the world over though they have not shown to improve survival. Other than the cost, these scans can lead further unnecessary tests like biopsies and can also result in increased radiation exposure. It is important to understand that these are general guidelines and the situation for every patient is different. However, it is important to have an informed discussion with your doctor to avoid these costly tests that have not shown to improve outcomes. Watch this space for more on how to decrease healthcare costs by limiting unnecessary testing.