title: High-cost imaging in elderly patients with stage IV cancer.
abstract: 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.
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA.
authors.forename: Yue-Yung
authors.initials: YY
authors.lastname: Hu
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Kwok
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Nathan
authors.initials: N
authors.lastname: Taback
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Loggers
authors.forename: Gladys V
authors.initials: GV
authors.lastname: Ting
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics; D057186:Comparative Effectiveness Research; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis / Q000191:economics; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000191:economics*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics; D018426:SEER Program; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014481:United States