Table 2.
High-Cost Imaging in the “Recent Care” Cohort (diagnosed between January 2002 and December 2006) of Stage IV Patients*
| Procedure type | Type of stage IV cancer, % | |||||
| Phase of care† | Breast | Colorectal | Lung | Prostate | All types | |
| All phases | n=3295 | n=11 106 | N=35 410 | n=5442 | N=55 253 | |
| CT | 92.7 | 94.1 | 95.0 | 85.3 | 93.7 | |
| MRI | 52.6 | 25.3 | 52.7 | 45.2 | 46.4 | |
| PET‡ | 26.8 | 22.6 | 32.5 | 5.5 | 27. | |
| NM | 80.6 | 33.3 | 57.4 | 86.8 | 56.9 | |
| All | 97.0 | 95.1 | 96.2 | 94.6 | 95.9 | |
| Diagnostic phase | n=3295 | n=11 106 | N=35 410 | n=5442 | N=55 253 | |
| CT | 73.6% | 85.4% | 90.5% | 54.4% | 84.9% | |
| MRI | 28.0% | 9.5% | 36.6% | 14.9% | 28.5% | |
| PET‡ | 11.5% | 7.4% | 23.6% | 1.2% | 17.4% | |
| NM | 61.6% | 17.8% | 44.3% | 66.9% | 42.2% | |
| All | 85.6% | 87.7% | 93.6% | 77.4% | 90.4% | |
| Continuing care phase | n=2667 | n=8291 | N=23 637 | n=5126 | N=39 721 | |
| CT | 73.1% | 69.6% | 67.9% | 67.3% | 68.5% | |
| MRI | 41.9% | 21.8% | 36.9% | 37.5% | 34.2% | |
| PET‡ | 24.7% | 24.0% | 20.9% | 4.8% | 19.7% | |
| NM | 58.9% | 22.7% | 30.1% | 62.2% | 34.6% | |
| All | 81.8% | 72.9% | 74.1% | 81.1% | 75.3% | |
| Last month of life | n=2472 | n=8904 | N=28 357 | n=3633 | N=43 366 | |
| CT | 26.3% | 25.9% | 31.1% | 25.7% | 29.3% | |
| MRI | 7.5% | 3.9% | 11.1% | 6.7% | 9.1% | |
| PET‡ | 0.9% | 0.8% | 1.3% | 0.2% | 1.1% | |
| NM | 7.5% | 3.6% | 6.3% | 8.3% | 6.0% | |
| All | 31.2% | 28.6% | 36.8% | 30.6% | 34.3% | |
*High-cost imaging procedures (CT, MRI, PET, and NM) have been defined by the Medicare Payment Advisory Commission. CT = computed tomography; MRI = magnetic resonance imaging; PET = positron emission tomography; NM = nuclear medicine.
†Diagnostic Phase = 60 days centered around SEER-Medicare-provided month of diagnosis; Continuing Care Phase = time between Diagnostic Phase and Last Month of Life; Last Month of Life = 30 days before death. Trumping rules were applied such that patients who died during the diagnostic phase were excluded from all other phases, and patients who died within 30 days of the end of the diagnostic phase were included in the last month of life analyses but excluded from continuing care.
‡A small number of PET scans may be misclassified as NM studies because the International Statistical Classification of Diseases and Related Health Problems, Version 9 (ICD-9) system does not contain separate PET codes.