Set Limits on Imaging in Late Stage Cancer Before Others Do
Some readers may recall that my wife passed away from a brain tumor last June, two years after her initial diagnosis. On March 16, her MRI prompted her providers to tell me that based on their experience with past brain tumor patients, she had about two months to live. Prior to leaving the imaging facility, we scheduled a follow-up MRI for May 16. Two days prior to the May appointment, my wife was in hospice care, no longer ambulatory, sleeping most of the time and taking very little food. I called the facility on May 15 and cancelled her MRI appointment, my rationale being that there was simply no point in conducting the scan. Now put my anecdote in the context of a study recently published in the Journal of the National Cancer Institute that showed that, the use of diagnostic imaging tests in Medicare patients with advanced (stage 4) cancer has risen faster than among patients with early-stage cancer. “The increasing use of imaging in late-stage cancer patients may be due to a lack of guidelines in this area or the use of imaging to help doctors manage symptoms, detect disease progression and assess the effects of treatment," said Dr. Yue-Yung Hu and colleagues at the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and the University of Wisconsin, in an interview with U.S. News and World Report. This was certainly the case with my wife. The fact is that for her, an MRI was of no clinical benefit whatsoever. She was near the end of her life, as the providers had predicted, and another scan would provide neither reduced suffering nor improved medical care. Actually, the physical act of getting her to the imaging facility would have been a great hardship for her, with no benefit whatsoever: That MRI would only have confirmed what we already knew and increase the anxiety and grief in our home. The problem was that no one on the healthcare side made the call to cancel the MRI, I chose to do it based on my own assessment of the situation. The best scenario would have been for the facility to have not made the initial appointment at all. But once they did, there should have been some system, a note in my wife’s records or some other flag, to make an end-of-life, pre-appointment assessment as to whether the scan was needed. If we are to combat the false perception that diagnostic imaging is overused (it can be, but it is not as pervasive as some would have us believe) and expensive (it is not, relative to its place in the continuum of care), we must take charge of our own systems and do a better job of policing ourselves. If we do not, based on recent history, someone else will do it for us.
With over 25 years of marketing experience — nine years as a former Vice President of Marketing for a leading healthcare marketing company — Steve Smith has consistently developed effective strategies to help fuel the growth of countless healthcare enterprises. Since 2007, he has specialized as a marketing and business development consultant to medical imaging facilities nationwide. Mr. Smith has been a featured speaker at imaging conferences and is a former member of the marketing subcommittee of the Radiology Business Management Association (RBMA). He has contributed marketing articles to numerous healthcare publications, including Physician’s Money Digest, Radiology Business Journal and more. Mr. Smith is the creator of “Ten Seconds to Great Customer Service™,” a medical imaging training program that provides easy-to-use tactical customer service support to staff.