The challenge of sustainability in healthcare systems: frequency and cost of diagnostic procedures in end-of-life cancer patients

Abstract

BackgroundLiterature data on the overuse and misuse of diagnostic procedures leading to end-of-life aggressiveness are scarce due to the limited amount of estimated economic waste. This study investigated the potential overuse of diagnostic procedures in a population of end-of-life patients.MethodsThis is a retrospective study on consecutive advanced patients admitted into two Italian hospices. Frequency and relative costs of X-ray imaging, CT scans, MRI, and interventional procedures prescribed in the 3 months before admission were collected in patient electronic charts and/or in administrative databases. We conducted a deeper analysis of 83 cancer patients with a diagnosis of at least 1 year before admission to compare the number of examinations performed at two distant time periods.ResultsOut of 541 patients, 463 (85.6%) had at least one radiological exam in the 3 months before last admission. The mean radiological exam number was 3.9 ± 3.2 with a relative mean cost of 278.60 ± 270.20 € per patient with a statistically significant (p < 0.001) rise near death. In the 86-patient group, a higher number of procedures was performed in the last 3 months of life than in the first quarter of the year preceding last admission (38.43 ± 28.62 vs. 27.95 ± 23.21, p < 0.001) with a consequent increase in cost.ConclusionsPatients nearing death are subjected to a high level of “diagnostic aggressiveness.” Further studies on the integration of palliative care into the healthcare pathway could impact the appropriateness of interventions, quality of care, and, ultimately, estimated costs.

Integration of oncology and palliative care: a Lancet Oncology Commission

“…In once recent study 258 it was reported that 57•4% of patients with metastatic lung, and 79•8% of patients with metastatic colorectal cancer believed that their surgery was likely to have been curative. Moreover there is also evidence that patients with advanced cancer are subject to increasing numbers of radiological investigations 259 and to a higher frequency of artificial nutritional support even in the context of decreased SACT. 260 Predicting survival in advanced cancer using prognostic tools Accurate staging can provide valuable prognostic information; can guide decision making about treatments at the individual patients level; allows for a common international terminology so that different centres can accurately describe the case-mix of their patients and can compare outcomes; and is essential for identifying homogenous populations for entry into clinical trials.…”

Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil

“…However, the overuse of medical imaging in dying patients with cancer increase costs and postpone hospice referrals. 36,37 Our findings also highlight the importance of medical data integration between outpatient and inpatient providers. In the community setting, medical records are sometimes paper-based and not well integrated resulting in poor information sharing and duplicate medical imaging.…”

Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil

“…17 This may be particularly relevant for limited-resource countries because the overuse of medical imaging in the last phase of life significantly increases health-care spending, despite questionable therapeutic benefits. 18 Our results indicated that more than a half of patients were admitted to ICU in the last 30 days of life. Over the last decade, therapeutic advances and better survival rates for the critically ill patient with HM have resulted in broader ICU admission policies around the world, including in Brazil.…”

“…24 We identified that 10% of patients used ARRT near death. Although the diagnosis of HM by itself is not a reason to withhold ARRT, 25 hemodialysis is associated with increased health-care costs, longer length of stays, 11 (16) 16 (18) .16…”

“…17 This may be particularly relevant for limited-resource countries because the overuse of medical imaging in the last phase of life significantly increases health-care spending, despite questionable therapeutic benefits. 18…”