{"id":49740,"date":"2017-10-30T07:56:09","date_gmt":"2017-10-30T07:56:09","guid":{"rendered":"https:\/\/www.biphoo.com\/bipnews\/?p=49740"},"modified":"2017-10-30T07:56:09","modified_gmt":"2017-10-30T07:56:09","slug":"patients-face-overtreatment-cancers","status":"publish","type":"post","link":"https:\/\/www.biphoo.com\/bipnews\/health\/patients-face-overtreatment-cancers.html","title":{"rendered":"Patients Face Overtreatment for Some Cancers"},"content":{"rendered":"

Patients Face Overtreatment for Some Cancers<\/span><\/strong><\/span><\/h2>\n

Patients Face Overtreatment for Some Cancers- When Annie Dennison was diagnosed with breast cancer last year, she readily followed advice from her medical team, agreeing to harsh treatments in the hope of curing her disease.<\/span><\/p>\n

\u201cYou\u2019re terrified out of your mind\u201d after a diagnosis of cancer, said Dennison, 55, a retired psychologist from Orange County, Calif.<\/span><\/p>\n

In addition to lumpectomy surgery, chemotherapy and other medications, Dennison underwent six weeks of daily radiation treatments. She agreed to the lengthy radiation regimen, she said, because she had no idea there was another option.<\/span><\/p>\n

Research published in The New England Journal of Medicine in 2010 showed that a condensed, three-week radiation course works just as well as the longer regimen. A year later, the American Society for Radiation Oncology, which writes medical guidelines, endorsed the shorter course.<\/span><\/p>\n

In 2013, the society went further and told doctors not to begin radiation on women like Dennison \u2014 who was over 50, with a small cancer that hadn\u2019t spread \u2014 without considering the shorter therapy.<\/span><\/p>\n

\u201cIt\u2019s disturbing to think that I might have been overtreated,\u201d Dennison said. \u201cI would like to make sure that other women and men know this is an option.\u201d<\/span><\/p>\n

Dennison\u2019s oncologist, Dr. David Khan of El Segundo, Calif., notes that there are good reasons to prescribe a longer course of radiation for some women.<\/span><\/p>\n

Khan, an assistant clinical professor at UCLA, said he was worried that the shorter course of radiation would increase the risk of side effects, given that Dennison had undergone chemotherapy as part of her breast cancer treatment. The latest radiation guidelines, issued in 2011, don\u2019t include patients who\u2019ve had chemo.<\/span><\/p>\n

Yet many patients still aren\u2019t told about their choices.<\/span><\/p>\n

An exclusive analysis for Kaiser Health News found that only 48 percent of eligible breast cancer patients today get the shorter regimen, in spite of the additional costs and inconvenience of the longer type.<\/span><\/p>\n

The analysis was completed by eviCore healthcare, a South Carolina-based medical benefit management company, which analyzed records of 4,225 breast cancer patients treated in the first half of 2017. The women were covered by commercial insurers. All were over age 50 with early-stage disease.<\/span><\/p>\n

The data \u201creflect how hard it is to change practice,\u201d said Dr. Justin Bekelman, associate professor of radiation oncology at the University of Pennsylvania Perelman School of Medicine.<\/span><\/p>\n

A growing number of patients and doctors are concerned about overtreatment, which is rampant across the health care system, argues Dr. Martin Makary, a professor of surgery and health policy at the Johns Hopkins University School of Medicine in Baltimore.<\/span><\/p>\n

From duplicate blood tests to unnecessary knee replacements, millions of patients are being bombarded with screenings, scans and treatments that offer little or no benefit, Makary said. Doctors estimated that 21 percent of medical care is unnecessary, according to a survey Makary published in September in Plos One.<\/span><\/p>\n

Unnecessary medical services cost the health care system at least $210 billion a year, according to a 2009 report by the National Academy of Medicine, a prestigious science advisory group.<\/span><\/p>\n

Those procedures aren\u2019t only expensive. Some clearly harm patients.<\/span><\/p>\n

Overzealous screening for cancers of the thyroid, prostate, breast and skin, for example, leads many older people to undergo treatments unlikely to extend their lives, but which can cause needless pain and suffering, said Dr. Lisa Schwartz, a professor at the Dartmouth Institute for Health Policy and Clinical Practice.<\/span><\/p>\n

\u201cIt\u2019s just bad care,\u201d said Dr. Rebecca Smith-Bindman, a professor at the University of California, San Francisco, whose research has highlighted the risk of radiation from unnecessary CT scans and other imaging.<\/span><\/p>\n

All eligible breast cancer patients should be offered a shorter course of radiation, said Dr. Benjamin Smith, an associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center.<\/span><\/p>\n

Studies show that side effects from the shorter regimen are the same or even milder than traditional therapy, Smith said.<\/span><\/p>\n

\u201cAny center that offers antiquated, longer courses of radiation can offer these shorter courses,\u201d said Smith, lead author of the radiation oncology society\u2019s 2011 guidelines.<\/span><\/p>\n

\u201cThere is no evidence in the literature to suggest that patients who receive chemotherapy will have a better outcome if they receive six weeks of radiation,\u201d said Smith who is currently updating the expert guidelines.<\/span><\/p>\n

Shorter courses save money, too. Bekelman\u2019s 2014 study in the Journal of the American Medical Association, found that women given the longer regimen faced nearly $2,900 more in medical costs in the year after diagnosis.<\/span><\/p>\n

The high rate of overtreatment in breast cancer is \u201cshocking and appalling and unacceptable,\u201d said Karuna Jaggar, executive director of Breast Cancer Action, a San Francisco-based advocacy group. \u201cIt\u2019s an example of how our profit-driven health system puts financial interests above women\u2019s health and well-being.\u201d<\/span><\/p>\n

Just getting to the hospital for treatment imposes a burden on many women, especially those in rural areas, Jaggar said. Rural breast cancer patients are more likely than urban women to choose a mastectomy, which removes the entire breast but typically doesn\u2019t require follow-up radiation.<\/span><\/p>\n

Meg Reeves, 60, believes much of her treatment for early breast cancer in 2009 was unnecessary. Looking back, she feels as if she was treated \u201cwith a sledgehammer.\u201d<\/span><\/p>\n

At the time, Reeves lived in a small town in Wisconsin and had to travel 30 miles each way for radiation therapy. After she completed her course of treatment, doctors monitored her for eight years with a battery of annual blood tests and MRIs. The blood tests include screenings for tumor markers, which aim to detect relapses before they cause symptoms.<\/span><\/p>\n

Yet cancer specialists have repeatedly rejected these kinds of expensive blood tests and advanced imaging since 1997.<\/span><\/p>\n

For survivors of early breast cancer like Reeves \u2014 who had no signs of symptoms of relapse \u2014 \u201cthese tests aren\u2019t helpful and can be hurtful,\u201d said Dr. Gary Lyman, a breast cancer oncologist and health economist at the Fred Hutchinson Cancer Research Center. Reeves\u2019 primary doctor declined to comment.<\/span><\/p>\n

In 2012, the American Society for Clinical Oncology, the leading medical group for cancer specialists, explicitly told doctors not to order the tumor marker tests and advanced imaging \u2014 such as CT, PET and bone scans \u2014 for survivors of early-stage breast cancer.<\/span><\/p>\n

Yet these tests remain common.<\/span><\/p>\n

Thirty-seven percent of breast cancer survivors underwent screening for tumor markers between 2007 and 2015, according to a study presented in June at the American Society of Clinical Oncology\u2019s annual meeting and published in the society\u2019s journal online.<\/span><\/p>\n

Sixteen percent of these survivors underwent advanced imaging. None of these women had symptoms of a recurrence, such as a breast lump, Lyman said.<\/span><\/p>\n

Beyond wasted time and worry for women, these scans also expose them to unnecessary radiation, a known carcinogen, Lyman said. A National Cancer Institute study estimated that 2 percent of all cancers in the United States could be caused by medical imaging.<\/span><\/p>\n

Health care costs per breast cancer patients monitored with advanced imaging averaged nearly $30,000 in the year after treatment ended. That was about $11,600 more than for women who didn\u2019t get such follow-up tests, according to Lyman\u2019s study. Women monitored with biomarkers had nearly $6,000 in additional health costs.<\/span><\/p>\n

Reeves knows the costs of cancer treatment all too well. Although she had health insurance from her employer, she says she had to sell her house to pay her medical bills. \u201cIt was financially devastating,\u201d Reeves said.<\/span><\/p>\n

\u201cIt\u2019s the worst kind of financial toxicity, because you\u2019re incurring costs for something with no benefit,\u201d said Dr. Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research.<\/span><\/p>\n

Even simple blood tests take a toll, Reeves said.<\/span><\/p>\n

Repeated needle sticks \u2014 including those from unnecessary annual blood tests \u2014 have scarred the veins in her left arm, the only one from which nurses can draw blood, she says. Nurses avoid drawing blood on her right side \u2014 the side of her breast surgery \u2014 because it could injure that arm, increasing the risk of a complication called lymphedema, which causes painful arm swelling.<\/span><\/p>\n

Reeves worries about the side effects of so many scans.<\/span><\/p>\n

After treatment ended, her doctor also screened her with yearly MRI scans using a dye called gadolinium. The Food and Drug Administration is investigating the safety of the dye, which leaves metal deposits in organs such as the brain. After suffering so much during cancer treatment, she doesn\u2019t want any more bad news about her health.<\/span><\/p>\n

Kathi Kolb, 63, was staring at 35 radiation treatments over seven weeks in 2008 for her early breast cancer. But she was determined to educate herself and find another option.<\/span><\/p>\n

\u201cI had bills to pay, no trust fund, no partner with a big salary,\u201d said Kolb, a physical therapist from South Kingstown, R.I. \u201cI needed to get back to work as soon as I could.\u201d<\/span><\/p>\n

Kolb asked her doctor about a 2008 Canadian study, which was later published in the influential New England Journal of Medicine, showing that three weeks of radiation was safe. He agreed to try it.<\/span><\/p>\n

Even the short course left her with painful skin burns, blisters, swelling, respiratory infections and fatigue. She fears these symptoms would have been twice as bad if she had been subjected to the full seven weeks.<\/span><\/p>\n

\u201cI saved myself another month of torture and being out of work,\u201d Kolb said. \u201cBy the time I started to feel the effects of being zapped (day) after day, I was almost done.\u201d<\/span><\/p>\n

A growing number of medical and consumer groups are working to educate patients, so they can become their own advocates.<\/span><\/p>\n

The Choosing Wisely campaign, launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation, aims to raise awareness about overtreatment. The effort, which has been joined by 80 medical societies, has listed 500 practices to avoid. It advises doctors not to provide more radiation for cancer than necessary, and to avoid screening for tumor markers after early breast cancer.<\/span><\/p>\n

\u201cPatients used to feel like \u2018more is better,\u2019 \u201d said Daniel Wolfson, executive vice president of the ABIM Foundation. \u201cBut sometimes less is more. Changing that mindset is a major victory.\u201d<\/span><\/p>\n

Source:-\u00a0http:\/\/www.vnews.com\/So-much-care-it-hurts-Unneeded-scans-therapy-surgery-only-add-to-patients–ills-13384620<\/span><\/p>\n

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