Radiological exams on end-stage oncologic patients before hospice admission

PURPOSE: To evaluate frequency, type, and cost of diagnostic and interventional radiological exams performed on end-stage oncologic patients in the 90 days before Hospice admission. MATERIALS AND METHODS: Data of patients admitted to Hospice from January 2012 through June 2013 (18 months) were cross-checked with data from the digital archive of the Radiology Department. Frequency and type of exams performed before admission were analyzed across three 1-month periods, namely M-3, M-2, M-1, corresponding to 90-61, 60-31 and 30-1 days before admission. The Regional Range of Fees was used to determine the costs. RESULTS: A total of 389 patients were admitted to Hospice. Before admission, 335 patients (86%) underwent 1543 radiological exams: 919 X-rays, 555 CTs, 39 MRs, and 30 interventional procedures. The cost of these services was EUR 106,988 (EUR 19,918 for X-rays, EUR 73,956 for CTs, EUR 9502 for MRs, and EUR 3612 for interventional procedures). Across the pre-Hospice periods, the proportions of examined patients increased as admission approached: 36% in M-3, 43% in M-2 (P = .038), 65% in M-1 (P < .001). The mean number of exams increased significantly, too (P < .001). CONCLUSIONS: A substantial number of end-stage oncologic patients underwent radiological exams in the 90 days before Hospice admission, and these numbers grew as Hospice access approached. In the end-of-life span, diagnostic excesses should be avoided.