Nonexpert information for patients increases inappropriate use of high-cost imaging

Multiparametric MRI accurately detects prostate cancer
Multiparametric MRI accurately detects prostate cancer

The increasing use of expensive medical imaging procedures in the United States such as positron emission tomography (PET) scans is being driven, in part, by patient decisions made after obtaining information from lay media and nonexperts, and not from health care providers.

That is the result from a 3-year-long analysis of survey data, which was published in Cancer Epidemiology, Biomarkers & Prevention (2014; doi:10.1158/1055-9965.EPI-13-0999). The authors were from the Annenberg School for Communication and the Hospital at the University of Pennsylvania in Philadelphia, and from the Dana-Farber Cancer Institute and Massachusetts General Hospital in Boston, Massachusetts.

Data for this analysis were obtained from a longitudinal cohort study comprising three annual mailed surveys between 2006 and 2008 and completed by patients with breast, prostate, or colorectal cancer. More than 2,000 persons participated in the study, funded by the National Cancer Institute.

“Clinical guidelines do not recommend PET for posttreatment surveillance among asymptomatic cancer survivors,” explained Andy S. Tan, PhD, a postdoctoral fellow at the Annenberg School for Communication at the University of Pennsylvania in Philadelphia. “Such procedures may result in unnecessary radiation exposure, anxiety, and morbidity associated with false-positive and false-negative results.”

The study sought to understand what drives cancer patients to seek such inappropriate procedures, to help inform interventions or policies to stem their overuse. The authors theorized that exposure to cancer-related information may play a role. They suggested that the potential benefit of new medical technologies receives substantial attention in the lay media and may promote positive attitudes toward the role of imaging technology such as PET.

The study looked at two variables: information seeking from nonclinician sources (eg, television, radio, books, brochures, newspapers, magazines, the Internet, family members, friends, coworkers, support groups, and other nonexpert sources) and patient-clinician information engagement (eg, treating physicians, other physicians, or health professionals).

They found that seeking information from nonmedical sources was predictive of subsequent reported PET scan use while patient-clinician information engagement was not. They noted that the overall use of PET scans for routine surveillance seems modest (10% to 11% of those cancer patients surveyed). However, this level of PET overuse may be problematic at the population level because of the large and growing number of cancer survivors.

“Our findings may have important implications for cancer survivors, health care providers, and health policy in the practice of advanced imaging use for routine follow-up,” the authors concluded, while raising a follow-up question: Are PET promotional materials used by health care facilities misstating the benefits of PET given that the use of PET imaging for routine cancer surveillance is inconsistent with clinical practice guidelines for most malignancies? “Policies or professional guidelines may be necessary to ensure that health care facilities convey accurate and reliable facts about the appropriate forms of cancer follow-up to patients.”

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