Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work
AUGUST 23, 2017
There is a growing conversation about testing used in surveillance of cancer survivors. This is due both to the increasing numbers of us as well as the availability of scans. There are some tests that are clearly needed (e.g. annual mammograms for women who have had breast cancer), others that are sometimes wise (e.g. breast for women at high risk) and others that rarely to never make sense (e.g. full body CT scans). How do you and your doctor think about this and make the right choices?
For some cancers, there are markers that are easily checked by blood tests (e.g. Ca125 for ovarian cancer) and are often reliable. Even for these, however, there are people for whom the results don't mean much and can't be used to safely track the presence or absence of cancer cells. The situation is highly variable even for individuals with the same cancer, and is very different from cancer type to cancer type.
I remember when women post breast cancer routinely received annual chest X-rays and bone scans along with blood draws to check markers. Those days are long gone, although some oncologists do continue (in spite of ASCO recommendations to the contrary) with markers. People who have had leukemia do surely need blood tests and, sometimes, bone marrows to confirm health or illness. Lots of people with more advanced cancers continue with periodic CT scans or MRIs or Pet Scans to evaluate the situation.
Let me be very clear that these decision are not only about cost. Yes, we have a major national problem with sky-rocketing health care costs, but that is not the main reason that oncologists are suggesting fewer tests. The primary reason is that these surveillance scans have generally not been proven to be helpful; they rarely extend life or make a difference in the treatment prescribed. The one thing that is certain is that tests raise everyone's level of anxiety!
From Reuters comes this helpful article:
Cancer survivors may seek unneeded tests for reassurance
Many people who survive cancer fear recurrence after their treatment ends, according
to a study that suggests these concerns may lead to unnecessary tests.
Data from 12 previously published studies involving 849 patients show that after completing treatment, patients want as many follow-up exams and tests as possible to reassure them that tumors have not returned, researchers found.
“Patients want intensive follow-up which comprises a lot of testing,” said senior study author Geertruida de Bock, of the University of Groningen in the Netherlands.
“Though this is understandable, it is not desirable since care for cancer is already under pressure due to rising numbers of survivors,” de Bock said by email.
Worldwide, an estimated 33 million people are cancer survivors. Their ranks are expected to grow due to rising cancer rates in an aging population as well as improved survival odds with advances in diagnosis and treatment.
As cancer increasingly becomes a chronic disease instead of a death sentence, doctors and patients are struggling to strike the right balance between doing enough follow-up tests to catch any new tumors quickly and avoiding too many needless tests that can lead to unnecessary interventions that don’t help people live longer.