The impact of local guidelines on the tumour marker requesting patterns of a General Surgery Department

Schulenburg‐Brand, Danja; Kumar, Nagappan; Zouwail, Soha

doi:10.1177/0004563213479942

Cited by 6 publications

(5 citation statements)

References 7 publications

(16 reference statements)

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“…These figures are not really different from those earlier provided by other two studies, the former also based in Italy and reporting that only 5% of the requests for cancer biomarkers testing were found to be coherent with international guidelines and recommendations (10), the latter based in Greece and concluding that proper requests for cancer biomarkers did not even approximate 10% (11). An indirect authentication that inappropriateness in cancer biomarkers testing is dramatically high comes from an interesting study, showing that establishing a culture of appropriateness based on interdepartmental collaboration and implementation of guidelines can be effective to decrease test ordering by 78% (12). Therapeutic drugs monitoring makes no exception to this rule, wherein inappropriateness of test ordering for monitoring theophylline and digoxin plasma values was found to be as high as 64.2% (13) and 45% (14) of all requests, respectively.…”

Section: Introductionmentioning

confidence: 99%

Inappropriateness in laboratory medicine: an elephant in the room?

2017

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Appropriateness of diagnostic testing can be conventionally described as prescription of the right test, using the right method, at the right time, to the right patient, with the right costs and for producing the right outcome. There is ongoing debate about the real burden of inappropriateness in laboratory diagnostics. The media coverage of this issue has also recently led to either over-or under-emphasizing the clinical, organizational and economic consequences. This is quite problematic, inasmuch as some reliable data are available in the current scientific literature, showing that inappropriateness of laboratory testing can be as high as 70%. This is especially evident for, though not limited to, cancer biomarkers testing, in which the practice of avoidable tests ordering is dramatically magnified. The reasons beyond inappropriateness are many and multifaceted, entailing wrong habits, resistance to changes, poor culture, insufficient education and healthcare inefficiencies. There are many unfavorable consequences attributable to avoidable testing, including unjustified incremental costs, derangement of laboratory efficiency and potential patient safety issues. The tentative solutions to this important problem necessitate that policymakers, local hospital administrators, laboratory professionals, clinicians, patients' associations and diagnostic companies join the efforts and embark in the same landmark effort for disseminating a better culture of appropriateness.

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Section: Introductionmentioning

confidence: 99%

Inappropriateness in laboratory medicine: an elephant in the room?

2017

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“…Moreover, we detected 155 male patients with a CA125 determination, a marker for ovarian cancer, that is 1.7% of all CA125 requests. Although, some cases might be explained by inadvertent and accidental requests, there are previous findings showing that up to 33% of patients with CA125 determinations are of male gender [47,48]. This large group of inappropriate requests could be caused by using lab block testing as a screening tool.…”

Section: Discussionmentioning

confidence: 97%

“…Laboratory forms with ready-made block orders are especially questionable in these cases. Schulenburg-Brand et al [47] have-in addition to training measures-set up a laboratory information system that automatically rejected CA125 requests in male patients and found an absolute decrease from 127 to 27 requests.…”

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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“…In view of the relatively scarce knowledge concerned with the actual causes of the inappropriateness of TM requests, due to lack of linkage between electronic requests and clinical records, 17, 24, 29, 36, 37 some models have been recently proposed to be effective in estimating the appropriateness of TM ordering in laboratories. Such models are usually based on incidence and prevalence data extracted on a regional scale for different malignancies.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate practice in tumor marker requests at a university hospital in Western Saudi Arabia: A 3-year retrospective study

Al-Mughales

Alahwal

2020

Int J Biol Markers

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Objectives: This study assessed the level of appropriateness of tumor marker requests in a teaching hospital and estimated the financial cost associated with inappropriate use. Methods: A retrospective review of patients’ electronic records was conducted over a 3-year period (2015–2017) for tumor marker requests, including carcinoembryonic antigen, alpha-fetoprotein, cancer antigen (CA)15-3, CA125, CA19-9, and total and free prostate-specific antigen (PSA and fPSA), along with the associated clinical data that motivated the requests. Inappropriate use was defined as tumor marker requests without any relevant clinical picture. Costs due to inappropriate tumor marker requests were estimated based on the unit costs applied in the institution. Results: A total of 7128 patients had at least one tumor marker request between 2015 and 2017. The clinical picture that motivated tumor marker requests was absent in 71.5%, while 12.9% of the requests were associated with a malignancy. The most frequent prescribing pattern was total prostate-specific antigen alone (2128; 29.9%), followed by alpha-fetoprotein alone (1185; 16.6%), and carcinoembryonic antigen alone (506; 7.1%). Year-over-year analysis revealed an increasing tendency in requesting carcinoembryonic antigen and CA15-3. The rate of inappropriate use varied by tumor marker and ranged between 56.4% for fPSA and 86.8% for total prostate-specific antigen. The overall costs due to inappropriate tumor marker requests were estimated at $2,785,493 over the 3 years, representing an average of $0.93 million per year. Conclusion: Inappropriate use of tumor marker requests is a major issue regarding its high prevalence and the considerable associated costs. The role of laboratories in the management of tumor marker requests should be emphasized.

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The impact of local guidelines on the tumour marker requesting patterns of a General Surgery Department

Cited by 6 publications

References 7 publications

Inappropriateness in laboratory medicine: an elephant in the room?

Inappropriateness in laboratory medicine: an elephant in the room?

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

Inappropriate practice in tumor marker requests at a university hospital in Western Saudi Arabia: A 3-year retrospective study

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