Unnecessary imaging studies … it’s on the docs!

Here in the USA, about half the patients diagnosed with low-risk prostate cancer are still (apparently) being sent for “guideline-discordant” (i.e., unnecessary) bone scans and CT scans, and a new research paper has clearly shown that it isn’t patient demand that is causing this to happen.

Between September 2014 and July 2015, Makarov et al. carried out a set of 22 interviews with prostate cancer patients and 17 interviews with physicians who cared for them at three Veterans Administration medical centers that represented a spectrum of inappropriate imaging rates.

Their research clearly showed the following with regard to the patients:

  • Patients had much less interest in prostate cancer staging as compared to disease treatment.
  • Many patients couldn’t even remember whether they’d had imaging tests at all.
  • The patients tended to texpress and exhibit trust in their doctors to make decisions about appropriate tests.
  • Some patients expressed mild concerns about radiation exposure, but their anxiety about cancer outcomes outweighed these concerns.

The results for the doctors were very different:

  • Most physicians self-reported that they know and trust imaging guidelines, but
  • Some physicians still tended to follow their own intuition, because of clinical suspicion or years of experience.
  • Physicians reported that a spectrum of other issues also affected their decisions, including
    • Medico-legal concerns
    • Fear of missing associated diagnoses
    • Influence from colleagues who image frequently
    • Influence of rates of imaging at the facility where they practice

It appears that we have a ways to go before we are going to be able to persuade the average urologist that most low-risk patients really don’t need a bone scan and a CT scan! And of course there are very real exceptions to every rule.

2 Responses

  1. That money should instead be spent on a 3-T mpMRI!

  2. I like the approach they took in Sweden — they publicly shamed doctors who didn’t follow bone scan guidelines: see
    Prostate cancer imaging trends after a nationwide effort to discourage inappropriate prostate cancer imaging“.

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