Use Of High-Cost Imaging In Elderly Patients With Metastatic Cancer

6112 Background: Diagnostic imaging is Medicare’s most rapidly growing service, and increasing rates of imaging have been documented among cancer patients. Like all interventions in patients with metastatic solid tumors, imaging may contribute to palliation but is unlikely to lead to long-term survival. We sought to determine patterns of imaging use in this population and to compare temporal trends with those observed among patients with curable early-stage disease. Methods: We extracted SEER-Medicare claims dated 1999-2007 for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer in 2000-2005 (n=64,267). High-cost imaging procedures were identified by CPT and/or ICD-9 codes for CT, MRI, PET, and nuclear medicine (NM) studies. Summary statistics were calculated, including percent of patients imaged and number of imaging procedures per patient. Comparable data were generated for patients with stage I-II disease of the same tumor types (n=127,827). Mean rates between groups were compared using the Wilcoxon test. We grouped patients according to year of diagnosis and compared utilization rates for the first and last year of the study period. Results: Stage IV patients underwent a mean of 2.4 high cost imaging procedures during the 60 day diagnostic period, compared to 0.8 in early stage patients (p<0.0001). Thereafter, stage IV patients underwent 0.7 high cost scans per month (1 scan every 43 days on average). 41% of stage IV patients were imaged in the last month of life. Over time, overall utilization increased in stage IV patients, while use decreased in early stage patients (Table). Conclusions: Patients with stage IV solid tumors undergo frequent high cost imaging. Imaging rates in this population are increasing over time, in contrast to the observed decrease in those with curable disease. There is an urgent need for studies to determine whether the benefits of these procedures justify the cost, measured in societal resources as well as patient discomfort and anxiety. Percent of patients imaged by year of diagnosis. 2000 2005 Change Stage I-II Any CT MRI PET NM 94% 86% 45% 11% 66% 87% 71% 32% 15% 60% −7% −15% −13% +4% −6% Stage IV Any CT MRI PET NM 94% 91% 39% 6% 62% 97% 94% 47% 32% 55% +3% +3% +8% +26% −7%