高龄 IV 期癌症患者的高成本影像学检查。
High-cost imaging in elderly patients with stage IV cancer.
机构信息
Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA.
出版信息
J Natl Cancer Inst. 2012 Aug 8;104(15):1164-72. doi: 10.1093/jnci/djs286. Epub 2012 Jul 31.
BACKGROUND
Medicare expenditures for high-cost diagnostic imaging have risen faster than those for total cancer care and have been targeted for potential cost reduction. We sought to determine recent and long-term patterns in high-cost diagnostic imaging use among elderly (aged ≥65 years) patients with stage IV cancer.
METHODS
We identified claims within the Surveillance, Epidemiology, and End Results (SEER)-Medicare database with computed tomography, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans between January 1994 and December 2009 for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer between January 1995 and December 2006 (N = 100,594 patients). The proportion of these patients imaged and rate of imaging per-patient per-month of survival were calculated for each phase of care in patients diagnosed between January 2002 and December 2006 (N = 55,253 patients). Logistic regression was used to estimate trends in imaging use in stage IV patients diagnosed between January 1995 and December 2006, which were compared with trends in imaging use in early-stage (stages I and II) patients with the same tumor types during the same period (N = 192,429 patients).
RESULTS
Among the stage IV patients diagnosed between January 2002 and December 2006, 95.9% underwent a high-cost diagnostic imaging procedure, with a mean number of 9.79 (SD = 9.77) scans per patient and 1.38 (SD = 1.24) scans per-patient per-month of survival. After the diagnostic phase, 75.3% were scanned again; 34.3% of patients were scanned in the last month of life. Between January 1995 and December 2006, the proportion of stage IV cancer patients imaged increased (relative increase = 4.6%, 95% confidence interval [CI] = 3.7% to 5.6%), and the proportion of early-stage cancer patients imaged decreased (relative decrease = -2.5%, 95% CI = -3.2% to -1.9%).
CONCLUSIONS
Diagnostic imaging is used frequently in patients with stage IV disease, and its use increased more rapidly over the decade of study than that in patients with early-stage disease.
背景
高成本诊断性影像学检查的医疗保险支出增长速度超过了癌症总护理支出，因此成为潜在的成本削减目标。我们旨在确定患有 IV 期癌症的老年（年龄≥65 岁）患者中近期和长期的高成本诊断性影像学使用模式。
方法
我们在监测、流行病学和最终结果（SEER）-医疗保险数据库中确定了 1994 年 1 月至 2009 年 12 月期间计算机断层扫描、磁共振成像、正电子发射断层扫描和核医学扫描的索赔记录，这些患者被诊断患有 IV 期乳腺癌、结直肠癌、肺癌或前列腺癌，诊断时间为 1995 年 1 月至 2006 年 12 月（N=100594 例患者）。我们计算了在诊断时间为 2002 年 1 月至 2006 年 12 月期间诊断为 IV 期患者的每个治疗阶段的成像患者比例和每位患者每月生存的成像率。我们使用逻辑回归估计了在 1995 年 1 月至 2006 年 12 月期间诊断为 IV 期患者的影像学使用趋势，并将其与同期具有相同肿瘤类型的早期（I 期和 II 期）患者的影像学使用趋势进行了比较（N=192429 例患者）。
结果
在 2002 年 1 月至 2006 年 12 月期间诊断为 IV 期的患者中，95.9%接受了高成本的诊断性影像学检查，每位患者平均有 9.79（SD=9.77）次扫描，每位患者每月生存 1.38（SD=1.24）次扫描。在诊断阶段之后，有 75.3%的患者再次接受了扫描；34.3%的患者在生命的最后一个月接受了扫描。在 1995 年 1 月至 2006 年 12 月期间，接受影像学检查的 IV 期癌症患者比例增加（相对增加=4.6%，95%置信区间[CI]为 3.7%至 5.6%），而接受早期癌症患者比例下降（相对减少=-2.5%，95%CI 为-3.2%至-1.9%）。
结论
在患有 IV 期疾病的患者中，诊断性影像学检查的应用较为频繁，在研究的十年中，其使用速度比早期疾病患者更快。
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