Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned

Júnior, Valter Paz do Nascimento; Camargos, Einstein Francisco

doi:10.5327/z2447-212320212000113

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…This result is of particular interest since there are only very few studies examining partially this issue. For example, a Brazilian retrospective analysis based on healthcare claims data from 2010 to 2017 examined the medical specialty of ordering physicians and found that, interestingly, most of the physicians were cardiologists (23.9%) [46]. However, numbers of insured patients were rather low and only 1112 TM tests were analyzed in the whole period.…”

Section: Discussionmentioning

confidence: 99%

Are Tumor Marker Tests Applied Appropriately in Clinical Practice? A Healthcare Claims Data Analysis

Stollberg,

Näpflin,

Nagler

et al. 2023

Diagnostics

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Tumor markers (TM) are crucial in the monitoring of cancer treatment. However, inappropriate requests for screening reasons have a high risk of false positive and negative findings, which can lead to patient anxiety and unnecessary follow-up examinations. We aimed to assess the appropriateness of TM testing in outpatient practice in Switzerland. We conducted a retrospective cohort study based on healthcare claims data. Patients who had received at least one out of seven TM tests (CEA, CA19-9, CA125, CA15-3, CA72-4, Calcitonin, or NSE) between 2018 and 2021 were analyzed. Appropriate determinations were defined as a request with a corresponding cancer-related diagnosis or intervention. Appropriateness of TM determination by patient characteristics and prescriber specialty was estimated by using multivariate analyses. A total of 51,395 TM determinations in 36,537 patients were included. An amount of 41.6% of all TM were determined appropriately. General practitioners most often determined TM (44.3%) and had the lowest number of appropriate requests (27.8%). A strong predictor for appropriate determinations were requests by medical oncologists. A remarkable proportion of TM testing was performed inappropriately, particularly in the primary care setting. Our results suggest that a considerable proportion of the population is at risk for various harms associated with misinterpretations of TM test results.

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Section: Discussionmentioning

confidence: 99%

Are Tumor Marker Tests Applied Appropriately in Clinical Practice? A Healthcare Claims Data Analysis

Stollberg,

Näpflin,

Nagler

et al. 2023

Diagnostics

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“…Overuse of a wide range of tests including CT and MRI scans, blood tests and endoscopies also emerged as a common problem, causing harm and waste in limited-resource settings. Two recent studies, from Brazil44 and China45 identified rates of inappropriate ordering of tumour markers, both in excess of 50%, underscoring the need for better regulation of the use of emerging medical technologies. A small number of qualitative studies identified drivers of these problems including fear of litigation and conflicts with patients, financial incentives, and expanding disease definitions 30 32.…”

Section: Discussionmentioning

confidence: 99%

Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review

et al. 2022

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ObjectiveOverdiagnosis and overuse of healthcare services harm individuals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any review of relevant evidence, we conducted a scoping review of the evidence around overdiagnosis and overuse of diagnostic and screening tests in LMICs.DesignScoping review.MethodsWe searched PubMed, Embase, PsycINFO, Global Index Medicus for relevant studies published until 24 May 2021, with no restrictions on date or language. We categorised included studies by major focus (overdiagnosis, overuse of tests, or both) and main themes (presence or estimates of extent; drivers; consequences and solutions).ResultsWe identified 2763 unique records and included 162 articles reporting on 154 studies across 55 countries, involving over 2.8 million participants and/or requests for tests. Almost half the studies focused on overdiagnosis (70; 45.5%), one-third on overuse of tests (61; 39.6%) and one-fifth on both (23; 14.9%). Common overdiagnosed conditions included malaria (61; 39.6%) and thyroid cancer (25; 16.2%), estimated to be >70% in China. Overused tests included imaging (n=25 studies) such as CT and MRI; laboratory investigations (n=18) such as serological tests and tumour markers; and procedures (n=14) such as colonoscopy. Drivers included fear of conflict with patients and expanding disease definitions. Common consequences included unnecessary treatments such as antimalarials, and wasted resources, with costs of malaria overdiagnosis estimated at US$86 million in Sudan in 1 year alone. Only 9% of studies discussed solutions, which included addressing inappropriately lowered diagnostic thresholds and reforming test-ordering processes.ConclusionsOverdiagnosis and overuse of tests are widespread in LMICs and generate significant harm and waste. Better understanding of the problems and robust evaluation of solutions is needed, informed by a new global alliance of researchers and policy-makers.

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“…Second, oxidative stress differs according to age, the oxidative stress hypothesis of aging assumes that age-associated functional losses are due to the accumulation of reactive oxygen and nitrogen species-induced damage [ 27 ]. At the same time, oxidative stress is involved in several age-related illnesses, such as cardiovascular disease, chronic obstructive pulmonary disease, neurodegenerative diseases, chronic kidney disease, and cancer [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Increased Oxidative Stress and Tumor Biomarkers Related to Polyaromatic Hydrocarbons Exposure for Different Occupational Workers in Makkah, Saudi Arabia

Adly¹,

Saleh²

2022

Cureus

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Introduction: Exposure to occupational polyaromatic hydrocarbons (PAHs) is correlated with several adverse effects on human health, including bladder, lung, and skin cancer. The correlation between PAH exposure and oxidative stress and tumor markers needs to be further explored. Therefore, we conducted this study to examine the effect of acute exposure to PAHs on oxidative stress and tumor marker levels in occupational workers during the Hajj season in Makkah. Methods: We conducted a cross-sectional study of 105 workers during Hajj; 60 workers were employed in the open air for ≥eight hours/day, exposed them to high levels of considerable traffic and huge crowds, and 45 workers served as our control group who were unexposed and working in a rural area. Using high-performance liquid chromatography, we analyzed participants' urinary 1-hydroxypyrene to determine PAH levels. Oxidative stress markers malondialdehyde (MDA), glutathione S-transferase (GST), and lactate dehydrogenase (LDH) were analyzed in serum using a spectrophotometer. The serum p53 and p21 proteins were analyzed using an enzyme-linked immunosorbent assay. We used IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA) to calculate multivariate logistic regression analysis for oxidative stress and tumor markers such as age, working period, and smoking status risk factors. Additionally, we evaluated associations between oxidative stress and tumor markers. Results: The mean levels of MDA, GST, and LDH were significantly elevated in exposed workers compared to the control group (p<.001). Also, p53 and p21 protein levels were significantly higher in the occupationally exposed group than in the unexposed control group (p<0.05). No significant correlation between age and increased levels of p53 and p21 was found. Conclusions: In our study, PAH exposure is significantly correlated with higher levels of oxidative stress and tumor marker levels in occupational workers. The evaluation of oxidative stress and tumor marker indicators can efficiently identify workers at high risk of PAH exposure and may assist in preventing future health concerns. More biomarkers should be included in other longitudinal studies to address exposure related to different health risks among workers, especially cancer risk. More prospective studies are required to validate diagnostic utilities and efficiencies of different biomarker combinations.

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Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned

Cited by 4 publications

References 29 publications

Are Tumor Marker Tests Applied Appropriately in Clinical Practice? A Healthcare Claims Data Analysis

Are Tumor Marker Tests Applied Appropriately in Clinical Practice? A Healthcare Claims Data Analysis

Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review

The Association of Increased Oxidative Stress and Tumor Biomarkers Related to Polyaromatic Hydrocarbons Exposure for Different Occupational Workers in Makkah, Saudi Arabia

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