{"id":6532,"date":"2019-10-08T15:58:19","date_gmt":"2019-10-08T19:58:19","guid":{"rendered":"https:\/\/www.med.unc.edu\/urology\/?p=6532"},"modified":"2020-04-08T16:02:47","modified_gmt":"2020-04-08T20:02:47","slug":"unc-led-study-comparing-tradeoffs-between-benefit-harm-and-cost-in-hematuria-evaluation-published-in-jama-internal-medicine","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/urology\/unc-led-study-comparing-tradeoffs-between-benefit-harm-and-cost-in-hematuria-evaluation-published-in-jama-internal-medicine\/","title":{"rendered":"UNC-led Study Comparing Tradeoffs Between Benefit, Harm, and Cost In Hematuria Evaluation Published in JAMA Internal Medicine"},"content":{"rendered":"<p class=\"lead\">Hematuria, or blood in the urine, is commonly encountered in clinical practice, with over 2 million American patients referred to urologists annually. The association of this finding with occult urinary tract cancer led to the development of several guidelines, with differing recommendations for evaluation. A study led by investigators at UNC\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2739056\" target=\"_blank\" rel=\"noopener noreferrer\">published in this week\u2019s print edition of JAMA Internal Medicine<\/a>\u00a0explores the tradeoffs of these different approaches.<\/p>\n<p class=\"lead\"><a href=\"http:\/\/news.unchealthcare.org\/som-vital-signs\/2019\/may-2\/nielsen-appointed-chair-of-aua-quality-improvement-and-patient-safety-committee\">Matthew Nielsen<\/a>, Associate Professor of Urology and Adjunct Associate Professor of Epidemiology and Health Policy &amp; Management, was the corresponding author for the study. Other UNC-affiliated investigators include Mihaela Georgieva,\u00a0<a href=\"https:\/\/sph.unc.edu\/adv_profile\/stephanie-b-wheeler-phd\/\" target=\"_blank\" rel=\"noopener noreferrer\">Stephanie Wheeler<\/a>, and Daniel Erim, from the Department of Health Policy and Management, and\u00a0<a href=\"https:\/\/www.med.unc.edu\/urology\/directory\/mathew-raynor-md-facs\/\">Mathew Raynor<\/a>\u00a0from the Department of Urology.<\/p>\n<script>\n\n    (function($) {\n        $(\"body, html\").addClass(\"heels_full_width_overflow\");\n    })(jQuery);\n\n   <\/script>\n   <div style=\"background-color:#4b9cd3;\" class=\"full-width-contained whitebackground \"><div class=\"row  oscitas-bootstrap-container\"><div class=\"col-lg-4 col-md-4 col-xs-12 col-sm-4 oscitas-bootstrap-container\">\n<p style=\"text-align: center;\"><a style=\"color: #fff; font-size: 2.0rem;\" href=\"https:\/\/www.med.unc.edu\/urology\/directory\/matthew-nielsen-md-ms\/\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6537 size-medium\" style=\"box-shadow: 0 4px 12px 0 rgba(0, 0, 0, 0.3);\" src=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-300x300.jpg\" alt=\"Matthew Nielsen, MD, MS\" width=\"300\" height=\"300\" srcset=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-300x300.jpg 300w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-150x150.jpg 150w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-768x768.jpg 768w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-1024x1024.jpg 1024w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-64x64.jpg 64w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/Nielsen_square-600x600.jpg 600w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Matthew Nielsen, MD, MS<\/a><\/p>\n<\/div><div class=\"col-lg-4 col-md-4 col-xs-12 col-sm-4 oscitas-bootstrap-container\">\n<p style=\"text-align: center;\"><a style=\"color: #fff; font-size: 2.0rem;\" href=\"https:\/\/sph.unc.edu\/adv_profile\/stephanie-b-wheeler-phd\/\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6536 size-medium\" style=\"box-shadow: 0 4px 12px 0 rgba(0, 0, 0, 0.3);\" src=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/wheeler_stephanie-e1570566121798-300x300.jpg\" alt=\"Stephanie B Wheeler PhD\" width=\"300\" height=\"300\" srcset=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/wheeler_stephanie-e1570566121798-300x300.jpg 300w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/wheeler_stephanie-e1570566121798-150x150.jpg 150w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/wheeler_stephanie-e1570566121798-64x64.jpg 64w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/wheeler_stephanie-e1570566121798-600x600.jpg 600w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/wheeler_stephanie-e1570566121798.jpg 738w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Stephanie B Wheeler, PhD, MPH<\/a><\/p>\n<\/div><div class=\"col-lg-4 col-md-4 col-xs-12 col-sm-4 oscitas-bootstrap-container\">\n<p style=\"text-align: center;\"><a style=\"color: #fff; font-size: 2.0rem;\" href=\"https:\/\/www.med.unc.edu\/urology\/directory\/mathew-raynor-md-facs\/\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6538 size-medium\" style=\"box-shadow: 0 4px 12px 0 rgba(0, 0, 0, 0.3);\" src=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-300x300.jpeg\" alt=\"Mathew C. Raynor, MD, FACS\" width=\"300\" height=\"300\" srcset=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-300x300.jpeg 300w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-150x150.jpeg 150w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-768x768.jpeg 768w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-1024x1024.jpeg 1024w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-64x64.jpeg 64w, https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/raynor-square-600x600.jpeg 600w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>Mathew Raynor, MD, FACS<\/a><\/p>\n<\/div><\/div><\/div>\n<h2>About The Study<\/h2>\n<p>The authors synthesized information from the published literature to create a computer-based microsimulation model of 100,000 patients presenting with hematuria. This study design permitted estimation of urinary cancer detection rates, costs, and harms, in particular, the risk of radiation-induced future cancer associated with exposure to CT imaging, across the recommendations from five current guidelines.<\/p>\n<p>The most intensive recommendation, recommending CT and cystoscopy for all adults, was associated with marginally higher cancer detection rates, though this cost twice as much per patient evaluated and was associated with an estimated risk of radiation-induced future cancer in more than one out of 200 patients evaluated, more than 10 times higher than the additional number of cancers detected. The authors conclude, \u201cThe balance of harms, advantages, and costs of hematuria evaluation may be optimized by risk stratification and more selective application of diagnostic testing in general and computed tomography imaging in particular.\u201d<\/p>\n<p>An\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2739052\" target=\"_blank\" rel=\"noopener noreferrer\">accompanying editorial<\/a>\u00a0notes that \u201cthis study sets a good example for future guidelines development,\u201d involving CT imaging, to the extent that the \u201cmorbidity and mortality associated with these radiation-induced cancers cannot be ignored.\u201d More information about the study can be found in a\u00a0New England Journal of Medicine <a href=\"#podcast\">Journal Watch podcast interview<\/a> with Dr. Nielsen (found below).<\/p>\n<h2>Hematuria \u2014 should the workup include imaging?<\/h2>\n<p><a name=\"podcast\"><\/a>August 8th, 2019<br \/>\nFrom: <a href=\"https:\/\/podcasts.jwatch.org\/index.php\/podcast-228-hematuria-should-the-workup-include-imaging\/2019\/08\/08\/\">Clinical Conversations<\/a> |<br \/>\n<i>Audio podcasts featuring the week&#8217;s news, plus your comments and pertinent interviews<\/i>.<\/p>\n<!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-6532-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/JWPodcast228.mp3?_=1\" \/><a href=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/JWPodcast228.mp3\">https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/JWPodcast228.mp3<\/a><\/audio>\n<p>&nbsp;<\/p>\n<blockquote><p>Matthew Nielsen and colleagues found almost 80 diagnostic algorithms for working up a finding of hematuria. From these, they chose five representative approaches, ranging from those based on the patients\u2019 risk factors to more aggressive ones that stress CT imaging for all.<\/p>\n<p>Using a 100,000-patient simulated cohort, Nielsen\u2019s group found that more intensive imaging found more cancers than the other approaches. However, radiation-induced cancers from CT wiped out that advantage.<\/p>\n<p>Join us as Dr. Nielsen walks through his findings and their clinical implications. The work appeared in JAMA Internal Medicine.<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>Hematuria, or blood in the urine, is commonly encountered in clinical practice, with over 2 million American patients referred to urologists annually. The association of this finding with occult urinary tract cancer led to the development of several guidelines, with differing recommendations for evaluation. A study led by investigators at UNC published in this week\u2019s print edition of JAMA Internal Medicine\u00a0explores the tradeoffs of these different approaches. Matthew Nielsen, Associate Professor of Urology and Adjunct Associate Professor of Epidemiology and Health Policy &amp; Management, was the corresponding author for the study. Other UNC-affiliated investigators include Mihaela Georgieva,\u00a0Stephanie Wheeler, and Daniel Erim, from the Department of Health Policy and Management, and\u00a0Mathew Raynor\u00a0from the Department of Urology.<\/p>\n","protected":false},"author":79967,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[1],"tags":[62,69],"class_list":["post-6532","post","type-post","status-publish","format-standard","hentry","category-news","tag-nielsen","tag-raynor","odd"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>UNC-led Study Comparing Tradeoffs Between Benefit, Harm, and Cost In Hematuria Evaluation Published in JAMA Internal Medicine | Department of Urology<\/title>\n<meta name=\"description\" content=\"Hematuria, or blood in the urine, is commonly encountered in clinical practice, with over 2 million American patients referred to urologists annually.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.med.unc.edu\/urology\/unc-led-study-comparing-tradeoffs-between-benefit-harm-and-cost-in-hematuria-evaluation-published-in-jama-internal-medicine\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"UNC-led Study Comparing Tradeoffs Between Benefit, Harm, and Cost In Hematuria Evaluation Published in JAMA Internal Medicine\" \/>\n<meta property=\"og:description\" content=\"Hematuria, or blood in the urine, is commonly encountered in clinical practice, with over 2 million American patients referred to urologists annually. The association of this finding with occult urinary tract cancer led to the development of several guidelines, with differing recommendations for evaluation. A study led by investigators at UNC published in this week\u2019s print edition of JAMA Internal Medicine\u00a0explores the tradeoffs of these different approaches. Matthew Nielsen, Associate Professor of Urology and Adjunct Associate Professor of Epidemiology and Health Policy &amp; Management, was the corresponding author for the study. Other UNC-affiliated investigators include Mihaela Georgieva,\u00a0Stephanie Wheeler, and Daniel Erim, from the Department of Health Policy and Management, and\u00a0Mathew Raynor\u00a0from the Department of Urology.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.med.unc.edu\/urology\/unc-led-study-comparing-tradeoffs-between-benefit-harm-and-cost-in-hematuria-evaluation-published-in-jama-internal-medicine\/\" \/>\n<meta property=\"og:site_name\" content=\"Department of Urology\" \/>\n<meta property=\"article:published_time\" content=\"2019-10-08T19:58:19+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-04-08T20:02:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.med.unc.edu\/urology\/wp-content\/uploads\/sites\/637\/2019\/10\/JAMA_IM_twitter.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1000\" \/>\n\t<meta property=\"og:image:height\" content=\"500\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Bradley Olson\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:title\" content=\"UNC-led Study Comparing Tradeoffs Between Benefit, Harm, and Cost In Hematuria Evaluation Published in JAMA Internal Medicine\" \/>\n<meta name=\"twitter:description\" content=\"Hematuria, or blood in the urine, is commonly encountered in clinical practice, with over 2 million American patients referred to urologists annually. The association of this finding with occult urinary tract cancer led to the development of several guidelines, with differing recommendations for evaluation. A study led by investigators at UNC published in this week\u2019s print edition of JAMA Internal Medicine\u00a0explores the tradeoffs of these different approaches. Matthew Nielsen, Associate Professor of Urology and Adjunct Associate Professor of Epidemiology and Health Policy &amp; Management, was the corresponding author for the study. 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The association of this finding with occult urinary tract cancer led to the development of several guidelines, with differing recommendations for evaluation. A study led by investigators at UNC published in this week\u2019s print edition of JAMA Internal Medicine\u00a0explores the tradeoffs of these different approaches. Matthew Nielsen, Associate Professor of Urology and Adjunct Associate Professor of Epidemiology and Health Policy &amp; Management, was the corresponding author for the study. Other UNC-affiliated investigators include Mihaela Georgieva,\u00a0Stephanie Wheeler, and Daniel Erim, from the Department of Health Policy and Management, and\u00a0Mathew Raynor\u00a0from the Department of Urology.","twitter_creator":"@UNCurology","twitter_site":"@UNCurology","twitter_misc":{"Written by":"Bradley Olson","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.med.unc.edu\/urology\/unc-led-study-comparing-tradeoffs-between-benefit-harm-and-cost-in-hematuria-evaluation-published-in-jama-internal-medicine\/#article","isPartOf":{"@id":"https:\/\/www.med.unc.edu\/urology\/unc-led-study-comparing-tradeoffs-between-benefit-harm-and-cost-in-hematuria-evaluation-published-in-jama-internal-medicine\/"},"author":{"name":"Bradley Olson","@id":"https:\/\/www.med.unc.edu\/urology\/#\/schema\/person\/e181406b46f5e69f26f8c788b9eb227f"},"headline":"UNC-led Study Comparing Tradeoffs Between Benefit, Harm, and Cost In 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