Experts warn that outdated guidelines may lead to unnecessary overtreatment of up to 5,000 men annually with prostate cancer in England, risking serious side effects. The charity Prostate Cancer UK calls for NICE to update its guidance to better reflect recent advances in testing and diagnosis, promoting active surveillance for low-risk cases to prevent harm and reduce the 'postcode lottery' in treatment approaches.
The article explores how the language and metaphors surrounding cancer, from silence to battle cries, influence perceptions, expectations, and treatment decisions, often leading to overtreatment. It advocates for reframing the illocutionary force of the word 'cancer'—shifting from a call to fight to a neutral diagnosis—to reduce unnecessary interventions and empower patient autonomy.
A study published in JAMA Internal Medicine highlights the increasing overtreatment of prostate cancer in older men with limited life expectancy in the U.S., despite guidelines recommending against it. Procedures like radiation therapy and surgery are often used unnecessarily, leading to side effects without extending life. The study suggests a "trifecta" method for discussing treatment options, emphasizing the importance of considering life expectancy in decision-making. Active surveillance is recommended for patients unlikely to benefit from aggressive treatments.
Older adults seeking healthcare are at risk of overtreatment and unnecessary screenings, with common medical tests like PSA, UTI, and diabetes screenings often not recommended after a certain age or without symptoms. Overuse of tests and treatments can lead to negative health consequences and contribute to antibiotic resistance. Providers and patients should engage in open dialogue to ensure that tests and screenings are necessary and beneficial, while being aware of recommended health screenings for older adults.
Older patients receiving thyroid hormone therapy with low thyrotropin levels are at an increased risk for cognitive disorders, including dementia, according to a study published in JAMA Internal Medicine. The study found that both exogenous and endogenous hyperthyroidism were associated with a higher likelihood of incident cognitive disorders. Women were more likely to have low levels of thyrotropin and be overtreated. The findings suggest that caution should be exercised when prescribing thyroid hormone therapy to older patients to avoid overtreatment and potential complications. Primary care physicians should consider consulting with endocrinologists for a differential diagnosis and treatment plan.
