Increased Monitoring Increases Cost, Not Quality of Care or Survival, in Prostate Cancer

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In an evaluation of SEER-Medicare data, researchers sought to determine the benefits of extreme use of monitoring in patients with metastatic prostate cancer at the end of life on survival outcomes, q
In an evaluation of SEER-Medicare data, researchers sought to determine the benefits of extreme use of monitoring in patients with metastatic prostate cancer at the end of life on survival outcomes, q

More frequent disease monitoring did not improve survival or quality of care, but rather only substantially increased healthcare costs at end of life (EOL) among patients with metastatic prostate cancer (mPCa), according to a study published in Cancer.

Disease assessment with prostate-specific antigen (PSA) testing, bone scans, and cross-sectional imaging are regularly utilized among patients with mPCa, but due to a lack of universal guidelines for monitoring, the impact on health and economic outcomes warrant further study.

For this study, investigators accessed the Surveillance, Epidemiology, and End Results-Medicare data and identified 3026 men with stage IV mPCa; men with additional malignancies and survived less than 6 months after diagnosis were excluded from the study. Researchers sought to evaluate the association between extreme use (more than 1 PSA testing/month; cross-sectional imaging or bone scans more frequently than every 2 months over 6 months), survival outcomes, cost, and quality of care at EOL.

Of the 3026 men, 26% (791) were identified as extreme users. Extreme users were more likely to be young, married, more educated, higher earning, and of white/non-Hispanic race.

No statistically significant differences were observed in regards to any quality-of-care indicators at EOL between extreme and nonextreme users over the last month of life, including visits to the emergency department, more than 1 hospital admission, ICU admission, hospitalization for more than 14 days, or timing of hospice referral.

There were no statistically significant differences in overall mortality or prostate cancer-specific mortality between extreme and non-extreme users.

Compared with nonextreme users, extreme users had a 22.9% (mean cost, $35,454) and 35.1% (mean cost, $62,672) higher cost of health care within the first year of diagnosis and the last year of life, respectively.

Results showed that there were no associations with improvement in quality of care or survival with more frequent monitoring, only increased cost. The authors concluded that “physicians are encouraged to discuss treatment goals with patients and to devise appropriate monitoring plans based on these goals.”

Reference

Golan R, Bernstein AN, Gu X, Dinerman BA, Sedrakyan A, Hu JC. Increased resource use in men with metastatic prostate cancer does not result in improved survival or quality of care at the end of life [published online March 26, 2018]. Cancer. doi: 10.1002/cncr.31297

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