Overuse of Health Care Services in the Management of Cancer

Abstract

Background Overuse, the provision of health services for which harms outweigh the benefits, results in suboptimal patient care and may contribute to the rising costs of cancer care. We performed a systematic review of the evidence on overuse in oncology. Methods We searched Medline, EMBASE, the Cochrane Library, Web of Science, SCOPUS databases, and two grey literature sources, for articles published between December 1, 2011 and March 10, 2017. We included publications from December 2011 to evaluate the literature since the inception of the ABIM Foundation’s Choosing Wisely initiative in 2012. We included original research articles quantifying overuse of any medical service in patients with a cancer diagnosis when utilizing an acceptable standard to define care appropriateness, excluding studies of cancer screening. One of 4 investigator reviewed titles and abstracts and 2 of 4 reviewed each full-text article and extracted data. Methodology used PRISMA Guidelines. Results We identified 59 articles measuring overuse of 154 services related to imaging, procedures, and therapeutics in cancer management. The majority of studies addressed adult or geriatric patients (98%) and focused on US populations (76%); the most studied services were diagnostic imaging in low-risk prostate and breast cancer. Few studies evaluated active cancer therapeutics or interventions aimed at reducing overuse. Rates of overuse varied widely among services and among studies of the same service. Conclusion Despite recent attention to overuse in cancer, evidence identifying areas of overuse remains limited. Broader investigation, including assessment of active cancer treatment, is critical for identifying improvement targets to optimize value in cancer care.

Determinants of the overuse of imaging in low-risk prostate cancer: A systematic review

“…It is unclear if the overreliance on claims data in this research area biases estimates of overuse. 29 Relatedly, without a critical mass of qualitative studies or surveys, we are unable to examine the association between putative determinants and patients or clinicians perceptions of overuse or any features of the actual medical decision making process. Finally, while the studies were consistent in defining overuse as guideline discordant care, various types of imaging were included in the outcome.…”

Medication overuse in oncology: current trends and future implications for patients and society

“…For this review, we combined evidence from a recent systematic review of direct evidence of overuse of health services in oncology 15 with a search for additional evidence of medication overuse in oncology including indirect evidence and an update of the prior review. We focused on examples of overuse related to medication prescribing and/or administration by healthcare providers.…”

“…14 Despite attention to the problem of overuse in recent years, 13 evidence of overuse in patients with cancer remains limited, with most studies focusing on diagnostic tests rather than treatments. 15,16 Reducing overuse is an attractive strategy for controlling costs while improving the overall quality of cancer care and optimizing patient outcomes.…”

La atención del cáncer en el Ecuador: pasado, presente y futuro

“…La primera está destinada a cubrir las dimensiones socio-culturales, el comportamiento y la salud mental de los individuos 9 mientras que la segunda se dedica a enfrentar los problemas funcionales o cualquier discapacidad resultante del cáncer, que provoque un impacto negativo en la calidad de vida de los pacientes 10 . Como parte de las estrategias contra el cáncer, diferentes países adoptan guías de práctica clínica oncológica, basadas en la mejor evidencia científica y aceptación internacional; no obstante, en los países desarrollados, en forma paralela, se argumenta la necesidad de evaluar el uso excesivo e inadecuado de la prestación de servicios de salud, incluyendo la administración de los tratamientos activos al evidenciarse que su uso incide en el cuidado del paciente pudiéndose limitar el objetivo inicial del tratamiento y contribuye al incremento de los costos de la atención del cáncer 11,12 .…”