A majority of older adults may disagree with the idea of using life expectancy as part of cancer screening guidelines, according to a new University of Michigan National Poll on Healthy Aging.
Background
The response goes against a trend in guidelines aimed at helping health-care providers decide when to recommend different tests to patients—which national organizations have developed based on medical evidence. Cancer screening guidelines have started to factor in life expectancy because the risks from some cancer screenings may increase with age and because previous studies have shown that patients may need to live about 10 years to achieve the full benefits of detecting cancer early.
“[M]any guidelines recommend considering the patient’s life expectancy,” explained poll contributor Brian Zikmund-Fisher, PhD, Professor, Co-Director of the Center for Bioethics and Social Sciences in Medicine, and a health-care decision-making researcher at the School of Public Health at University of Michigan. “But when it comes to a discussion between a health-care provider and an individual patient, personalizing the cancer screening decision essentially means talking about how long that person is expected to live. It also means sometimes deciding that not doing a screening is actually the healthiest approach,” he added.
Findings From the New Poll
In the new poll—based on findings from a nationally representative survey conducted by the National Opinion Research Center at the University of Chicago for the Institute for Healthcare Policy and Innovation at the University of Michigan—researchers asked 2,563 respondents aged 50 to 80 years whether they disagreed somewhat or disagreed strongly with the idea of cancer screening guidelines using life expectancy. They found that 26% of respondents strongly disagreed with this.
The researchers found that 62% of the respondents stated that national guidelines for when to end cancer screenings in individual patients should not be based on their life expectancies.
Even among the respondents who were characterized as “medical minimizers” because they preferred to avoid medical interventions unless they were necessary, 57% of them disagreed with the idea of using life expectancy in cancer screening guidelines. Although the proportion of disagreement among those in the medical minimizers group wasn’t statistically different than the 62% of those whose answers were in the middle, it was much lower than the 73% of those characterized as “medical maximizers.”
Meanwhile, 70% of the older adults who participated in the poll noted that they didn’t consider it a problem if some older adults received cancer screenings when the guidelines didn’t recommend them.
When the researchers asked specifically about the 10-year life expectancy limit—which has already been incorporated into some guidelines—55% of the respondents said it was “about right,” and 27% of them said it was “too short.”
Strong disagreement was more common among female respondents than male respondents (30% vs 21%) and female respondents were also more likely to disagree with the use of life expectancy in guidelines about both continuing screening (62% vs 50%) and ending screening (66% vs 57%).
Strong disagreement with the use of life expectancy in guidelines about ending cancer screenings was also higher among Black respondents than among White or Hispanic respondents (37%, 24%, and 28%, respectively).
Further, 74% of the White respondents didn’t see a problem with older adults undergoing cancer screenings against the guidelines that applied to them compared with 61% of Black respondents and 61% of Hispanic respondents. The researchers indicated that non-Hispanic White patients tend to have the most access to cancer screenings.
Implications of the New Findings
The new findings are timely as a result of a federal court case that could lead to the end of required insurance coverage for cancer screenings and other preventive care based on national guidelines.
“Right now, insurance plans must cover the cost of cancer screenings for [patients] in the groups covered by guidelines set by the U.S. Preventive Services Task Force,” detailed poll director Jeffrey Kullgren, MD, MPH, MS, Associate Professor of Internal Medicine at Michigan Medicine and a researcher at the U.S. Department of Veterans Affairs Ann Arbor Healthcare System. “Depending on how the courts eventually rule, insurance coverage of some cancer screenings could end for some older adults, because insurers would be allowed to set their own standards for coverage and not have to abide by guidelines,” he stressed.
In addition, the researchers revealed that cancer screening guidelines may change if new evidence emerges regarding which patients receive the most benefit from the screenings. For instance, a draft U.S. Preventive Services Task Force guideline may soon take effect to lower the age for the start of screening mammograms to 40, while continuing to find insufficient evidence for screening female patients over 75.
Conclusions
“Personalizing cancer screening decisions to each patient’s health situation, rather than using one-size-fits-all age cutoffs, could benefit both very healthy and less healthy patients in different ways,” Dr. Zikmund-Fisher concluded.
Disclosure: The new poll was supported by the American Association of Retired Persons (AARP) and Michigan Medicine. For more information on the poll, visit deepblue.lib.umich.edu.
