When people learn they have medical conditions, they naturally leap to the next step: treatment. But choosing the right treatment is not always a black-and-white process, particularly for men with prostate cancer. Each person’s injury or disease is affected by his or her gender, age, lifestyle and other medical needs. There is rarely only one option or one-size-fits-all treatment, which is why utilization management plays such a critical role in assessing treatment options. When men are diagnosed with conditions such as cancer, diabetes or high blood pressure, it is crucial for them to seek second opinions and create personalized treatment plans with their physicians.
Prostate cancer is a major health risk facing older men in the U.S. There are thousands of new cases and deaths related to prostate cancer every year. But unlike with most other cancers, there is a type of prostate cancer that may not need aggressive treatment right away. In fact, recent studies showed some older men with prostate cancer may be over-treated leading to unnecessary complications, CNN reported.
Many men have prostate cancer, but it can be a slow-growing form of the disease. These men may not need aggressive treatment immediately. The side effects from prostate cancer treatment can sometimes prove quite serious. One such example is with anti-androgen hormonal therapy. While an effective therapy, especially when combined with orchiectomy or an LHRH agonist, it can create muscle weakness, osteoporosis, hot flashes and impotence. Other low-risk prostate cancer treatments include surgery and radiation, and those, too, can lead to incontinence and impotence.
If a man is found to have prostate cancer, he needs to have a serious discussion with one or more physicians about his type of cancer and whether it has spread or is likely to spread in the body.
Diabetes and Hypertension
Both Type 1 and Type 2 diabetes in men require intensive medical treatment. The amount of treatment needs to be assessed and altered as the patient improves. Researchers from the University of Michigan, Ann Arbor, found when patients are given medications to reduce their blood pressure or blood sugar, these treatments weren’t always stopped or reduced – which they called de-intensification – when appropriate blood pressure or sugar levels were achieved.
When patients had very low blood pressure, only 18.8 percent had their treatments de-intensified. At moderately low blood pressure, 16 percent of patients saw de-intensification for treatment. When patients had low hemoglobin A1c levels – low blood sugar – only 27 percent underwent a reduction in treatment. About 20 percent of patients who achieved moderately low blood sugar saw de-intensification.
Monitoring a patient’s drug intake or reducing treatment when appropriate is critical to long term disease management. For example, if a patient with high blood pressure is taking medication that lowers their blood pressure excessively, serious side effects can occur including increased risk of dizziness, fainting, blurred vision, depression and thirst. In diabetes treatment, it’s also important to consider that low blood sugar can lead to losses of consciousness, seizures and death.
Researchers and physicians agree that high blood pressure can lead to dangerous medical problems, including heart disease and stroke. However, there is less agreement on when individuals older than 60 should be treated for high blood pressure.
Some studies have suggested that treating blood pressure so that the systolic pressure (the top number) is below 120 mm HG may not be any better for people than leaving their blood pressure between 120 and 139 mm HG, NPR reported. This may be particularly true for older patients who are on other medications or could have a sensitivity to drugs. Some researchers recommend treating patients 60 and older when their blood pressure reaches 150/90 instead of when it is above 140 mm HG.
However, the American Heart Association continues to recommend treating patients for high blood pressure at 140/90 until they reach 80. After this age, treatment should begin at 150/90. When a man is diagnosed with high blood pressure, it is up to him and his physician to determine the correct course of action and whether medications are necessary.
Create Individualized Care Plans
There is always a small risk of over-treatment, particularly as men age and certain health issues are less likely to reduce a man’s quality of life or lead to death. Men shouldn’t leave health issues untreated without discussing their options with a physician, but they also should weigh what is the right amount of treatment.
Men and their physicians need to make individualized treatment plans after discussing the various options and health risks. They should then consistently revisit these plans and medications. Diet and exercise is a major factor in men’s health and can reduce the need for medications or lower the necessary dosage.
Benefits of UR
Knowing the right course of treatment isn’t always easy. Physicians use their best judgement and men must do the same. But if you, one of your physicians or your insurance company is worried that your current care isn’t right for you, utilization review allows for an evidence-based assessment of the course of treatment.
Dr. Carnel of Advanced Medical Reviews (AMR), an independent review organization, explains, “AMR understands the role that utilization management and evidence-based utilization reviews have in quality patient care. “ Advanced Medical Reviews is proud to be a part of helping individuals receive the best care possible. We are recognized as a URAC accredited utilization management company, and we use an evidence-based approach to review patient treatment plans.