Data Stream
High Costs, Low Adherence
Doctor Versus Computer
A recent study of Medicare beneficiaries diagnosed with
chronic myeloid leukemia (CML) found that high upfront, outof-pocket costs can force patients to delay starting treatment.
Are doctors destined to go the way of travel
agents and phone operators, being replaced by
computers? Not likely, according to a headto-head, man-versus-machine comparison
conducted by researchers from Brigham &
Women’s Hospital in Boston, Massachusetts.
Focusing on 393 older patients (≥66 years old) who were
diagnosed with CML between 2007 and 2011, researchers
found that
at six months postdiagnosis, only
The study compared the diagnostic accuracy of
245 human physicians with 23 different symptom
checkers (medical diagnostic software tools used
on sites like WebMD.com) in 45 different clinical
vignettes. Physicians and symptom checkers were
asked to provide and rank three diagnoses.
Humans were twice as accurate
as the symptom checkers:
68%
of patients started
treatment with a
tyrosine kinase inhibitor.
• correct diagnosis listed first:
72.1% vs. 34.0%
• correct diagnosis listed in the top 3
diagnoses: 84.3% vs. 51.2%
“Clinical diagnosis is as much art as it is science,
but there is great promise for technology to help
augment clinical diagnoses,” the authors wrote.
“That is the true value proposition of these tools.”
Source: Semigran HL, Levine DM, Nundy S. Comparison of
physician and computer diagnostic accuracy. JAMA Intern
Med. 2016 October 10. [Epub ahead of print]
When patients had access to subsidies to help cover the
cost of these drugs, the delay in starting treatment was
significantly shorter: 58 days vs. 108 days.
These patients also
started treatment
Brew a Cup of Cancer Prevention
The best part of waking up could also be lowering your risk of developing certain types of cancer,
according to a meta-analysis of 105 prospective studies exploring the association of coffee consumption and cancer incidence.
Coffee intake (1 cup per day) was found to lower the relative risk of six types of cancer:
35
%
colon
cancer
60
50
faster.
“Delayed initiation among individuals without cost-sharing
subsidies suggests that out-of-pocket costs may be a barrier
to timely initiation of therapy among individuals diagnosed
with CML,” the authors concluded.
Source: Winn AN, Keating NL, Dusetzina SB. Factors associated with tyrosine
kinase inhibitor initiation and adherence among Medicare beneficiaries with
chronic myeloid leukemia. J Clin Oncol. 2016 October 3. [Epub ahead of print]
40
oral
cancer
30
20
10
0
31%
prostate
cancer
pharynx
cancer
54%
liver
cancer
melanoma
27%
13%
11%
11%
Source: Wang A, Wang S, Zhu C, et al. Coffee and cancer risk: A meta-analysis of prospective observational studies. Sci Rep. 2016
September 26. [Epub ahead of print]
32
ASH Clinical News
December 2016