Cancer Patients Rarely Request Inappropriate Tests, Treatments

A new study debunks the common assumption that high medical costs are a result of patients demanding more tests and treatments. Researchers analyzed more than 5000 patient-clinician visits and found that cancer patients rarely push for medical interventions.

The study, published in JAMA Oncology, found that just 8.7% of patient visits included a patient demanding or requesting additional tests and treatments. Clinicians complied with 83% of the requests they deemed clinically appropriate. For the 50 demands for clinically inappropriate tests or treatments, clinicians only complied with 7 of them, which is just 0.14% of the total 5000 encounters.

“We decided to look specifically at cancer patients’ demands because oncology is a setting where there are life-and-death stakes for patients, and the drugs and tests can get very expensive,” senior author Ezekiel Emanuel, MD, PhD, chair of the department of medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania, said in a statement. “However, we found, contrary to expectations, that patient demands are low and cannot be a key driver of increasing healthcare costs.”

Half of the requests were for imaging studies, 13.6% for laboratory tests, such as tumor markers, and 5.2% were for genetic tests or chemosensitivity tests. The authors were surprised to learn that 15.5% of patients requested palliative care interventions such as pain medications or sleeping aids.

“In this age of unregulated consumer medical information on the Internet, it’s encouraging to see that this hasn’t translated to cancer patients requesting inappropriate—and often costly—tests and treatments,” lead author Keerthi Gogineni, MD, MSHP, said.

The 60 clinicians—34 oncologists, 11 oncology fellows, and 15 nurse practitioners and physician assistants—were from 3 Philadelphia hospitals: the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Pennsylvania Hospital.

Patients with lung/head and neck cancer and receiving active treatments were more likely to make demands or requests. The relationship with the clinician also had an affect; patients with worse relationships with their physicians were more likely to request or demand additional tests or treatment.

“Given the rarity of clinically inappropriate demands or requests, that few were high cost, and that few were complied with, they are unlikely to add significantly to health care costs,” the authors concluded in their paper.