August 9th, 2011 by Elaine Schattner, M.D. in Opinion, Research
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We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”
In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough –
The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.
They review published findings on the topic: Read more »
*This blog post was originally published at Medical Lessons*
July 5th, 2011 by admin in Health Policy, Health Tips
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If you are a smoker, or love someone who smokes, the specter of lung cancer is ever looming. Wouldn’t it be great if there was a way to detect lung cancer in its earliest and most curable stages, much like the goal of mammograms for breast cancer?
Although it seems like common sense to do such advance checks—a process called lung cancer screening—studies to date haven’t shown that finding lung cancer early translates into fewer deaths from the disease.
A new report in the New England Journal of Medicine suggests that screening heavy smokers with yearly low-dose CT scans can reduce deaths from lung cancer by 20% compared to screening with chest x-rays. The results are from the National Lung Screening Trial, which included more than 53,000 current and former heavy smokers between the ages of 55 and 74. (Preliminary results from this trial were covered in the Harvard Health Letter and in the Harvard Health blog.) Read more »
*This blog post was originally published at Harvard Health Blog*
July 1st, 2011 by PJSkerrett in Health Tips, Research
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Without meaning to, you’ve gained a few pounds over the last few years. How did that happen? Certain foods, especially the humble potato, may be partly to blame.
In a fascinating study of 120,000 healthy, non-obese women and men taking part in long-term studies of diet and health, the participants gained an average of 3.3 pounds every four years over a 13-year period. When the researchers tallied up the foods that contributed most to this weight gain, potatoes topped the list—twice:
- potato chips
- potatoes
- sugar-sweetened beverages
- red meat
- processed meats
Other contributors to weight gain included sleeping less than six hours a night or more than eight hours, drinking alcohol, and watching television. The results were just published in The New England Journal of Medicine.
The study offered some good news and tips for losing weight, too. Foods and lifestyle choices associated with losing weight included Read more »
*This blog post was originally published at Harvard Health Blog*
June 29th, 2011 by Elaine Schattner, M.D. in Health Policy, Opinion
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This is the second in a series of posts on Bending the Cost Curve in Cancer Care. We should consider the proposal, published in the NEJM, gradually over the course of this summer, starting with “suggested changes in oncologists’ behavior,” #1:
1. Target surveillance testing or imaging to situations in which a benefit has been shown. This point concerns the costs of doctors routinely ordering CTs, MRIs and other imaging exams, besides blood tests, for patients who’ve completed a course of cancer treatment and are thought to be in remission.
The NEJM authors consider that after a cancer diagnosis many patients, understandably, seek reassurance that any recurrence will be detected early, if it happens. Doctors, for their part, may not fully appreciate the lack of benefit of detecting a liver met when it’s 2 cm rather than, say, just 1 cm in size. What’s more, physicians may have a conflict of interest, if they earn ancillary income by ordering lab and imaging tests.
My take:
It’s clear that some and possibly most cancer patients get too many and too frequent post-treatment surveillance tests. Read more »
*This blog post was originally published at Medical Lessons*
June 22nd, 2011 by Elaine Schattner, M.D. in Health Policy
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Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The author’s take on this problem:
Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…
The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:
Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1): Read more »
*This blog post was originally published at Medical Lessons*
