Many With Terminal Cancer Still Getting Routine
TUESDAY, Oct. 12 (HealthDay News) -- Many patients with
incurable cancer are still being screened for common cancers,
although these tests are unlikely to provide any benefit,
researchers from Memorial Sloan-Kettering Cancer Center in New York
City have found.
Specifically, many patients diagnosed with advanced lung,
colorectal, pancreatic, gastroesophageal or breast cancer are still
undergoing the ordeal of routine breast, prostate and colon cancer
screening, said the researchers. Not only might these patients
suffer from invasive procedures like colonoscopies near the end of
life, the researchers said, but they face the unnecessary risk of
additional tests, biopsies and psychological distress resulting
from the detection of new malignancies.
"For patients living with advanced cancer, cancer screening should not be a routine procedure," said lead researcher Dr. Camelia S. Sima, an assistant attending biostatistician.
"Patients living with advanced malignancies and their doctors should engage in a realistic conversation about the risks and benefits associated with cancer screening in [the] face of a severely limited life expectancy," she added.
The report is published in the Oct. 13 issue of the
Journal of the American Medical Association.
For the study, Sima's team collected data on 87,736 Medicare
patients aged 65 years or older with advanced lung, colorectal,
pancreatic, gastroesophageal or breast cancer, whose data was
reported in the Surveillance, Epidemiology, and End Results (SEER)
These patients were followed from their diagnosis, between 1998
and 2005, until they died or to the end of 2007.
To compare the findings to a control group, the researchers also
collected data on 87,307 similar Medicare patients without cancer,
who were matched with the other individuals for age, race, sex and
SEER data. In both patient groups, Sima's team looked at the rates
of mammograms for breast cancer, Pap tests for cervical cancer,
prostate-specific antigen (PSA) tests for prostate cancer and
endoscopy for colon cancer.
The investigators found that among women with advanced cancer,
8.9 percent had a mammogram, compared with 22 percent of those
without cancer; and 5.8 percent of the cancer patients had a Pap
test, compared with 12.5 percent of those without cancer.
Among men, 15 percent of those with advanced cancer had a PSA
test for prostate cancer, compared with 27.2 percent of those
Among all patients, 1.7 percent of those with advanced cancer
underwent a colonoscopy to check for colon cancer, compared with
4.7 percent of those without cancer, the researchers found.
Patients who had been screened more often were more likely to
continue being screened after being diagnosed with advanced cancer,
as were those who were wealthier and married, Sima's group
There needs to be greater awareness that cancer screening when
one is near the end of life is unlikely to provide a benefit, Sima
"Screening guidelines could be reassessed to address the appropriateness of screening for patients whose very limited life expectancy due to advanced cancer negates any potential benefit that may be derived," Sima said.
Commenting on the study, Dr. Len Lichtenfeld, deputy chief
medical officer at the American Cancer Society, said that "we can
do a lot of good with screening, but we have to recognize that
there comes a time when it's simply not the right thing to do."
Lichtenfeld suggested that patients should discuss the
appropriateness of a screening test with their doctor. "Putting
people at the end of life through screening is not appropriate for
the person, and from a societal viewpoint, it's not a good use of
our limited resources," he said.
"Why would this happen in the first place?" Lichtenfeld asked. "It flies in the face of compassion; it flies in the face of common sense."
In addition, he noted, should a test find a cancer, then what
happens? "I hope doctors would not be doing additional procedures
on people who are nearing the end of their lives," Lichtenfeld
For more information on cancer screening, visit the
U.S. National Cancer Institute.
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