Why do patients not return for follow-up imaging?

More than 36 percent of patients with indeterminate abdominal imaging findings don’t return for follow-up imaging, according to a new study published in the American Journal of Roentgenology. But what factors lead to this ongoing trend?

“When an imaging finding is indeterminate or a finding suspicious for cancer is detected, follow-up imaging within a designated time frame is typically recommended,” wrote Joshua K. Cho, MD, department of radiology at the Hospital of the University of Pennsylvania in Philadelphia, and colleagues. “However, even in breast and cervical cancer screening, as many as 30 percent of patients with indeterminate findings are lost to follow-up after one year. Lack of follow-up in these situations can result in missed or delayed diagnoses and represent preventable harm.”

The authors studied data from more than 1,500 patients with indeterminate abdominal imaging findings at a single institution between July 1, 2013, and March 20, 2014. More than 36 percent of those patients did not undergo follow-up imaging within one year of their initial examination. More than 28 percent of outpatients and more than 60 percent of emergency department patients did not undergo follow-up imaging.

Also, more than 12 percent of patients who did not undergo follow-up imaging were over the age of 80.

“Even after exclusion of patients who had died, a higher proportion of older patients were found in the group who did not undergo follow-up imaging, suggesting that older patients may be less likely to return for follow-up imaging,” the authors wrote. “Older age is a known risk factor for higher incidence of many conditions and worse outcomes of many interventions. These patients may be less likely to return for follow-up imaging owing to prioritization of more urgent comorbidities, decreased need for follow-up if they have an advanced illness (e.g., metastatic cancer), difficulty with access to care, or a number of potential communication pitfalls. Radiologists should remain cognizant of these factors when recommending follow-up imaging or other downstream testing.”

The patient’s distance from the hospital did correlate with less follow-up imaging, but only in the outpatient setting.

“The relation between distance to hospital and follow-up completion was not robust and likely requires further investigation,” the authors wrote.