Thursday, April 5, 2012

Hold that test!

Yes, skip some of those lovely little medical adventures, please. I have heard in the news that 9 medical boards have recommended 40 something tests/procedures (a/k/a medical adventures)  to help reduce medical costs. I have heard a few of them - skip antibiotics for the common cold for example - but wasn't sure of the rest. In the days of high medical costs, over diagnosis, and over treatment, any little adventure we can skip, save me a seat! I heard some appalling number the other day of something like $3 trillion is the amount Americans spend on medical care each year - and I might be missing a digit  maybe $35 trillion?

ASCO, or the American Society of Clinical Oncology, has made five recommendations of tests or treatments for cancer patients.

"The list emerged from a two-year effort by an American Society of Clinical Oncology (ASCO) task force, similar to a project other medical specialties are undertaking, to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely performed.

As much as 30% of health-care spending goes to procedures, tests, and hospital stays that do not improve a patient's health, according to a 2008 analysis by the nonpartisan Congressional Budget office."

The first recommendation is: "...that patients who have been successfully treated for breast cancer and have no symptoms of cancer not undergo CT, PET, other imaging, or bone scans to check for recurrence."

ASCO recommends against routine use of four other procedures: chemotherapy for patients with advanced cancers who are unlikely to benefit; advanced imaging technologies such as CT and PET or bone scans to stage early breast and prostate cancers at low risk for metastasis; and drugs to stimulate white blood cell production in patients receiving chemotherapy if they have a risk of febrile neutropenia."

Hmmm... I had a bone scan at my breast cancer diagnosis because I was also experiencing some weird leg pain issues. I did have a PET scan after treatment at one point because there was a 'suspicion' and with my history they need to be sure (blah, blah, blah). I was also hospitalized for febrile neutropenia in the middle of chemo and then had some drugs to take (which I cant remember their name or exactly when) after each session of that chemo.

So what do I think of these changes? I know they are being done with an eye on controlling costs. However some of these greatly ease the patient's mind. If all my friends are getting PET scans why aren't I getting them too - the lemming mentality? I see it all the time on cancer boards. 'I get that test twice a year, you demand your doctor get you that test as well.'  People often don't think about costs when their insurance pays for them.  And peace of mind is invaluable to patients during and after treatment - they just want to make sure its not there.

While I see benefit in annual mammograms for women with or without a breast cancer diagnosis, I do not really see the benefit of regular CT, PET or bone scans for asymptomatic cancer patients. Fewer trips to the hospital make me a happy girl.

Finally while these are guidelines meaning they are general rules, each cancer patient needs to talk to their doctor about what is appropriate for their needs. A good doctor will be able to give solid reasons why or why not a medical adventure is needed. So once again, go talk to your doctor and see what is right for you.

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