Researchers: Cancer Screening Recommendations May Depend on Time of Day

By Jonathan Springston, Editor, Relias Media

Do all physicians tell every patient who needs to undergo a cancer screening test about it? It could depend on the time of day when the physician treats the patient, according to the authors of a recently published study.

Researchers inspected data on 50,000 adult patients who were eligible for either colorectal cancer screening or breast cancer screening. These patients visited 33 primary care clinics in New Jersey and Pennsylvania between 2014 and 2016. Physicians ordered screenings more often for patients who visited earlier in the day. For patients with 8 a.m. appointments, the investigators found physicians ordered breast cancer screening and colorectal cancer screening for eligible patients 64% and 37% of the time, respectively. Conversely, for patients who visited at 5 p.m., physicians ordered breast cancer and colorectal cancer screenings 48% and 23% of the time, respectively. Further, patients who visited earlier in the day and did receive a cancer screening recommendation were more likely to follow through on actually going in for a test.

Investigators attributed this phenomenon to possible “decision fatigue, defined as the depletion of self-control and active initiative that results from the cumulative burden of decision-making.” The authors theorized that as the work day progresses, physicians may fall behind, which could lead to shorter interactions with patients. And patients who visit physicians at the end of the day may be eager to keep their visits short, too.

“As the day goes on, clinicians may be less likely to discuss cancer screening with patients simply because they have already done this (and made other decisions) a number of times. As patients earlier in the day decline screening despite the clinician’s recommendation, it could influence how likely the clinician is to bring up the topic later in the day with a different patient,” the authors explained. “In our analysis, no observable differences were found between characteristics of patients who had visits at different times of day. However, it could be the case that patients who see their clinician later in the day want to leave sooner and decline a discussion about cancer screening.”

Although the authors acknowledged possible limitations to this study (such as its observational nature and the fact data were collected from one health system), they stressed “decisions made during a single [primary care physician] visit may have a lasting effect on patient behavior.”

“Future interventions targeting improvements in cancer screening should consider how time of day influences these behaviors,” the authors concluded.

Often, physicians work long hours in high-stakes environments, treating dozens of patients with few breaks and little room for error. This endless cycle of work and stress could lead to burnout. In episode 15 of the podcast series “Rounds with Relias,” we interview a physician who explains what burnout is and its root causes.

Regarding colorectal cancer screening, federal lawmakers are considering legislation that would make it easier for patients to undergo such tests. (Read more about it in the April issue of Same-Day Surgery). On a related note, in the May 15 issue of Internal Medicine Alert, Joseph Scherger, MD, MPH, explained the importance of dietary fiber for overall good health, especially the gut microbiome.

In other cancer-related news, the CDC this week said it is seeking public comment on updating federal guidelines regarding potential cancer clusters in communities and how relevant public health authorities can respond to those emergencies. In the April 1 issue of Emergency Medicine Reports, authors Chandni Ravi, MD, and Maureen Gang, MD, detailed exciting advancements in cancer treatment therapies along with potential complications.

“Although emergency providers are familiar with the adverse effects of older therapies, such as neutropenic fever and tumor lysis syndrome, the rapidly changing landscape of cancer therapy requires providers not only to keep abreast of treatment guidelines for these better-known complications, but also to familiarize themselves with the newer modalities and their associated toxicities and treatment options,” the authors wrote.