Value Measures

Hutchinson Institute for Cancer Outcomes Research

Value Measures

Use of advanced imaging, such as PET, CT and bone scans at the end of life can create unnecessary anxiety, lead to unnecessary tests or procedures, and create additional medical bills for patients without prolonging life or improving its quality.

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There is no evidence that using advanced imaging tests helps with treatment of survival for early breast cancers.  Using imaging when it is not recommended can cause patient harm when they lead to unnecessary invasive procedures, overtreatment, misdiagnosis, exposure to radiation, increased cost and create anxiety and uncertainty associated with a false-positive result.

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Blood tumor marker tests and/or advanced imaging beyond mammography are not recommended in the absence of concerning symptoms or physical examination findings. There is no evidence that these tests improve patient
quality of life or alter survival.

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Expert guidelines recommend using CSF for patients who are receiving chemotherapy that has a high risk of developing febrile neutropenia, and not using CSF for chemotherapy where the risk of febrile neutropenia is low. Studies have shown that CSF use in actual practice does not follow these recommendations.

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For patients with advanced cancers who fail to respond to several recommended treatments, preserving quality of life is an important consideration. Studies have shown that in these situations, additional treatments are not likely to be effective, and expose patients to side effects that negatively impact quality of life.

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Cancer experts and patient advocates now recognize and promote the need for high quality, coordinated care at the end of life. Inpatient and outpatient based hospice care is designed to give supportive care to
patients in the final phase of a terminal illness, focusing on patient comfort and quality of life.

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Hospitalizations during treatment are generally unexpected and potentially preventable. The likelihood of hospitalization can be minimized with comprehensive management of a patient’s symptoms, including plans for anticipating and treating side effects before they become severe.

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For patients whose cancer is incurable and in the terminal phase, careful planning and management of
needs, symptoms, expectations and preferences should reduce the number of unplanned emergency department visits hospital stays.

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The risk of unplanned hospitalization following surgery may be reduced with an understanding of patient-specific risks for complications and a comprehensive management plan that includes prevention and early intervention when symptoms appear.  

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Place of death is now an indicator of the quality of end-of-life care. Currently a large proportion of deaths from
terminal illnesses occur in hospitals. Improving patient education, addressing goals of care early in the disease course, and providing supportive services offered outside the hospital at the time of death increases patient and family well-being.

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Prostate cancers are considered low risk when Gleason scores and PSA level results fall below specific thresholds, indicating it is highly unlikely that the cancer has spread to other organs. Unnecessary imaging can lead to patient harm when they lead to unnecessary invasive procedures, overtreatment, misdiagnosis, and increased cost.

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