Key Points:
Breast and prostate cancer screening were more frequent among patients on hemodialysis waitlisted for kidney transplant.
Among patients not waitlisted for transplant, we found that screening rates were generally higher among patients with higher predicted 5-year survival.
Among patients not waitlisted for transplant and with the highest predicted 5-year survival, there was a deficit of screening compared with waitlisted patients.
Background: The Choosing Wisely campaign suggests an individualized approach to cancer screening among patients receiving dialysis. We aimed to evaluate breast and prostate cancer screening among patients receiving maintenance hemodialysis by kidney transplant waitlist status and 5-year survival probability.
Methods: We conducted a retrospective cohort study using a nationally representative population of hemodialysis patients. Patients receiving hemodialysis each calendar year from 2003 to 2018, ≥1 year of Medicare as the Primary Payer, and age 50–69 years were included. The cohort was split into prognosis and cancer screening sets. Models of 5-year survival were built in the prognosis set using logistic regression. Five-year survival probabilities were generated in the cancer screening set, excluding patients with prior breast or prostate cancer, and screening over the next year was assessed.
Results: One hundred sixty thousand five hundred thirty-seven patients contributed 356,165 person-years to the cancer screening set (59% of the person-years were contributed by males, median age was 60 years). Compared with a benchmark rate of 50% (e.g., mammography every other year), 42% of waitlisted female-years were screened by mammography. Overall, 17% of nonwaitlisted female-years were screened (20% among those with >50% probability of 5-year survival and 8% among those with <10% probability of 5-year survival). Compared with a benchmark rate of 20% (e.g., serum prostate-specific antigen screening up to 5 years apart), 24% of waitlisted male-years were screened with serum prostate-specific antigen. Overall, 15% of nonwaitlisted male-years were screened (13% among those with >50% probability of 5-year survival and 11% among those with <10% probability of five-survival). Patterns were similar after age-standardization.
Conclusions: Patients with higher predicted survival have higher rates of cancer screening, suggesting providers consider life expectancy. However, nonwaitlisted patients with high probability of 5-year survival were less likely to be screened compared with waitlisted patients. Interventions may be needed to close this screening gap.