‘Maximizer’ patients get more cancer surveillance but not better outcomes

The aggressiveness with which some low-risk cancers are surveilled has more to do with the preferences of the patient than the state of the disease. Consequently, patients who want more scans and tests tend to raise their costs and risks of overtreatment without improving their outcomes.

Megan Haymart, MD, of the University of Michigan and colleagues confirmed the hypothesis by surveying 2,183 disease-free patients who were previously diagnosed with thyroid cancer.

Based on survey responses, the researchers classified patients as minimizers of follow-up medical services (31.6%), moderate maximizers (42.5%) and strong maximizers (25.9%).

After controlling for numerous factors, including age, sex, race, comorbidity and cancer stage, the team found strong maximizers were much more likely to report, over the previous year, four or more doctor visits, two or more neck ultrasounds, one or more radioactive iodine scans and/or one or more additional imaging exams.

Citing prior research showing increased surveillance by imaging and other means does not clearly correlate with improved outcomes, the authors recommend “stronger consideration of the role of patient preferences” when considering surveillance strategies.

The study is running in the Journal of Clinical Oncology.

In a news item posted by Michigan Medicine, Haymart says the team believes thyroid cancer “can serve as a model for the impact of patient attitudes on medical resource use following surgery in other low-risk cancers, such as indolent prostate and breast cancers.”