Cancer Patients Rarely Requested Unnecessary Treatments

Cancer patients asking for unnecessary tests and treatments a rare occurrence during cancer treatment

(RxWiki News) Going to your doctor and demanding a treatment that is unwarranted may lead to unnecessary costs. But a new study of cancer patients suggests that this request is likely a rare occurrence.

This new study surveyed cancer care providers following encounters with patients to examine the nature of such demands.

The study found that demands or requests for unnecessary tests and treatments were rare, and the execution of these treatments were even rarer.

"Have open discussions with your doctor about what treatments and tests are best for your health."

"There are many calls for physicians to provide more cost-effective care. Physicians sometimes claim that patients demand high cost or low value tests and treatments," explained the authors of this new study, which was led by Keerthi Gogineni, MD, MSHP, of the Abramson Cancer Center at the University of Pennsylvania in Philadelphia.

Dr. Gogineni and team aimed to examine how often cancer patients demanded these unnecessary medical services. To do so, they did a survey of clinicians, including oncologists (cancer physicians) and nurse practitioners.

The surveys were completed immediately after interactions with patients, and asked about any patient requests for tests or treatments, if the request was thought to be an appropriate one, and if the request was granted by the medical team.

The study included 2,050 encounters between 26 clinicians and their patients, who had an average age of 60 years. A total of 66.3 percent of the participants were undergoing active treatment for their cancer. Of these patients, 42 percent had an advanced stage cancer or cancer that was resistant to treatment.

Dr. Gogineni and team found that only 8.6 percent of these encounters included a patient request or demand for treatment or testing. Of the 177 encounters that did include a request, only 13.6 percent were deemed inappropriate by the oncologist or nurse practitioner, while 79.7 percent were determined to be appropriate by the clinician.

The clinicians declined a patient's request in 18.1 percent of the 177 cases. Of the cases in which clinicians declined requests, 84.4 percent were because the clinician thought the treatment or test requested was inappropriate or there was not sufficient evidence that it would be beneficial.

The researchers also found that a test or treatment requested by a patient that the clinician judged to be inappropriate was only executed in 0.2 percent of cases, or in 4 out of 2,050 encounters.

"Inappropriate patient demands for tests or treatments are very uncommon among cancer patients and probably do not drive high utilization of high cost or low value medical services," concluded Dr. Gogineni and team.

In an interview with dailyRx News, Alexander Kutikov, MD, academic urologic surgical oncologist at Fox Chase Cancer Center in Philadelphia, noted that the medical decision-making explored in this study is a complicated process requiring efforts from both parties.

"Patients should be encouraged and often become active participants in their care," said Dr. Kutikov. "The study suggests that in the proper context of a healthy patient-physician relationship, physicians are able to effectively navigate patients toward appropriate utilization of healthcare resources and away from unnecessary testing and/or intervention."

However, Dr. Kutikov noted that the same findings may not necessarily hold true in all fields of medicine.

"The study was conducted in the oncology space where patient-physician bonds tend to be extremely strong," Dr. Kutikov told dailyRx News. "It would be interesting to see if findings differed in other branches of medical practice.

"Medical decision-making can be extremely complex," he said. "Physicians must appropriately contextualize and explain available choices to the patient and allow the patient to arrive at an appropriate decision using their own value system as a guide."

"This process can be extremely challenging, especially when all choices involve significant uncertainties and risks," said Dr. Kutikov.

This research by Dr. Gogineni and team will be presented at the American Society of Clinical Oncology (ASCO)'s annual meeting in June. Studies presented at conferences are considered preliminary until published in a peer-reviewed journal.

No conflicts of interest were noted.

Review Date: 
May 14, 2014