High-Cost Imaging in Elderly Patients with Stage IV Cancer

Background Medicare expenditures for high-cost diagnostic imaging have risen faster than those for total cancer care and have been targeted for potential cost reduction. We sought to determine recent and long-term patterns in high-cost diagnostic imaging use among elderly (aged ≥65 years) patients with stage IV cancer. Methods We identified claims within the Surveillance, Epidemiology, and End Results (SEER)-Medicare database with computed tomography, magnetic resonance imaging, positron emission tomography, and nuclear medicine scans between January 1994 and December 2009 for patients diagnosed with stage IV breast, colorectal, lung, or prostate cancer between January 1995 and December 2006 (N = 100 594 patients). The proportion of these patients imaged and rate of imaging per-patient per-month of survival were calculated for each phase of care in patients diagnosed between January 2002 and December 2006 (N = 55 253 patients). Logistic regression was used to estimate trends in imaging use in stage IV patients diagnosed between January 1995 and December 2006, which were compared with trends in imaging use in early-stage (stages I and II) patients with the same tumor types during the same period (N = 192 429 patients). Results Among the stage IV patients diagnosed between January 2002 and December 2006, 95.9% underwent a high-cost diagnostic imaging procedure, with a mean number of 9.79 (SD = 9.77) scans per patient and 1.38 (SD = 1.24) scans per-patient per-month of survival. After the diagnostic phase, 75.3% were scanned again; 34.3% of patients were scanned in the last month of life. Between January 1995 and December 2006, the proportion of stage IV cancer patients imaged increased (relative increase = 4.6%, 95% confidence interval [CI] = 3.7% to 5.6%), and the proportion of early-stage cancer patients imaged decreased (relative decrease = -2.5%, 95% CI = -3.2% to -1.9%). Conclusions Diagnostic imaging is used frequently in patients with stage IV disease, and its use increased more rapidly over the decade of study than that in patients with early-stage disease.     

Inappropriate utilization of radiographic imaging in men with newly diagnosed prostate cancer in the United States

BACKGROUND:

The use of radiographic imaging (bone scan and computerized tomography) is only recommended for men diagnosed with high‐risk prostate cancer characteristics. The authors sought to characterize utilization patterns of imaging in men with newly diagnosed prostate cancer.

METHODS:

The authors performed a population‐based observational cohort study using the US Surveillance, Epidemiology, and End Results‐Medicare linked data to identify 30,183 men diagnosed with prostate cancer during 2004 to 2005.

RESULTS:

Thirty‐four percent of men with low‐risk and 48% with intermediate‐risk prostate cancer underwent imaging, whereas only 60% of men with high‐risk disease received imaging before treatment. Radiographic imaging utilization was greater for men who were older than 75 years (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.20‐1.37; P < .001), were black (OR, 1.11; 95% CI, 1.01‐1.21; P = .030), resided in wealthier areas (OR, 1.19; 95% CI, 1.08‐1.32 for median income >$60,000 vs <$35,000; P < .001), lived in rural regions (OR, 1.23; 95% CI, 1.12‐1.36; P < .001), or underwent standard radiation therapies (OR, 1.71; 95% CI, 1.60‐1.84; P < .001). Imaging utilization was less for men living in areas with greater high school education (OR, 0.83; 95% CI, 0.75‐0.91 between highest and lowest graduation rates; P < .001) or opting for active surveillance (OR, 0.17; 95% CI, 0.15‐0.19 vs radical prostatectomy; P < .001). The estimated cost of unnecessary imaging over this 2‐year period exceeded $3.6 million.

CONCLUSIONS:

In the United States, there is widespread overutilization of imaging for low‐risk and intermediate‐risk prostate cancer, whereas a worrisome number of men with high‐risk disease did not receive appropriate imaging studies to exclude metastases before therapy. Cancer 2012;. © 2011 American Cancer Society.     

Developing and testing an instrument to measure the presence of conditions for successful implementation of quality improvement collaboratives

Background  

In quality improvement collaboratives (QICs) teams of practitioners from different health care organizations are brought together to systematically improve an aspect of patient care. Teams take part in a series of meetings to learn about relevant best practices, quality methods and change ideas, and share experiences in making changes in their own local setting. The purpose of this study was to develop an instrument for measuring team organization, external change agent support and support from the team's home institution in a Dutch national improvement and dissemination programme for hospitals based on several QICs.     

PET/CT在放射性粒子组织间种植治疗恶性实体肿瘤

放射性粒子组织间种植治疗优点是治疗区定位精确,靶区剂量高,正常组织的损伤小;与手术、化疗配合有互补作用可以保护机体功能及形态的效应。PET/CT同机完成了功能图象和解剖图像的融合。功能图象在肿瘤的诊断和治疗疗效评估以及预后的判断中突破了WHO传统的实体肿瘤影像学评价标准。其次,解剖图像和融合图像可以指导肿瘤活检、外科手术、放疗靶区确定等。PET/CT对肿瘤特异的分子靶点成像,定义肿瘤细胞的这一分子标记并给出治疗方案;治疗效果在功能和解剖图像上被发现、标记、评估。PET/CT引导下放射性粒子组织间种植治疗晚期恶性实体肿瘤的应用将克服常规粒子植入肿瘤治疗模式中存在的或多或少的经验主义,为实现肿瘤放射治疗的客观性和个体化提供可能,实现真正的生物适形放疗。     

Control of the large renal vein in limited dissected space during laparoscopic nephrectomy: A simple and reliable method

We describe our technique for large renal vein control in the limited dissected space during laparoscopic nephrectomy. This technique is a simple, inexpensive and reliable method, especially for large and short renal vein ligation.     

NIA0005Long-term weight maintenance: does diet composition matter? A randomized, prospective trial

Background:  High protein diets confer weight loss and metabolic advantages over high carbohydrate diets in the short-to-medium term. Little has been published on long-term use of high protein diets, especially in the context of weight maintenance following significant weight loss.
Methods:  The study consisted of two phases. The first phase saw patients provided with a very low energy diet for 12 weeks. Patients who lost > 10% of their body weight progressed to the second phase in which they were randomly allocated to a high carbohydrate (HC) (55% carbohydrate) or high protein (HP) diet (30% protein) to maintain their weight loss. Patients were followed up monthly for 12 months. Anthropometric and cardiovascular risk factors were measured.
Results:  A total of 173 overweight or obese people (88 males, 85 females) aged 43 years (SD = 10.6); weight 112.2 kg (±24.6); Body Mass Index 39.2 kg/m² (±7.7) were enrolled. 151 patients (87.3%) completed phase I and entered phase II. There was no significant difference between the weight loss recorded during phase I for each group after randomization (mean weight loss 18.5 kg ±6.9 kg and 17.7 ± 5.0 respectively). On average, patients from both groups were reasonably successful in maintaining their weight loss at completion of phase II (HC 14.7 ± kg 12.5 vs. HP 14.8 kg ± 9.7), with no significant difference between the groups.
Conclusion :   Although a high protein diet compares favourably to a high carbohydrate diet in the short-to-medium term, in this study a high protein diet exhibited no advantage over a higher carbohydrate diet in achieving weight maintenance over a 12 month period.     

环青海湖地区重点人群投服碘油丸前后碘营养状况的调查

目的了解青海省环湖地区重点人群的碘营养状况,以及服用碘油丸后的变化情况,为今后在青海省推广碘盐困难地区和边远地区对重点人群投放碘油丸提供可靠的理论依据。方法盐碘检测采用半定量方法进行;尿碘检测采用WS／T 107-1999标准进行:水碘检测采用砷铈氧化还原法;8-10岁学龄儿童甲状腺检查采用触诊法进行。结果环湖地区孕妇、哺乳妇女尿碘中位数分别为96．0、90．6μg／L,8-10岁儿童、育龄妇女的尿碘中位数虽高于100μg／L,但<50μg／L的比例均>20％;服碘油丸前农牧区儿童、妇女的碘营养水平较城镇低,尿碘中位数均<80 μg／L。服药后5组重点人群的尿碘水平均有不同程度的提高,以农牧区的提高最明显。结论青海省环湖地区5组重点人群的碘营养状况不理想,以孕妇、哺乳妇女缺碘最严重,8-10 岁儿童的尿碘水平不能完全反映其他重点人群的碘营养水平。