Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 324: Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider

Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spen ding your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

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You have found yourself smack dab in the middle of Episode #324 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10). Make sure you don’t miss that info. Keep up with the class.

On the personal end of things….. Whack a mole Roller coaster of business Nothing is guaranteed. Nothing. Up and down up and down. If you’re a follower of the podcast, you’ll know you’ve heard shows when I was riding high. Killing it. 20-25 new patients per week. 185-200 visits a week by myself. Then Periods of time like more recently when I have been seeing COVID era numbers and running low on funds while funding new clinic endeavors. Then, we start recovering from that and we’re on the way back up. Just in time for the local VA to hire themselves an acupuncturist and a chiropractor so many of our new patients and visits will begin to start to disappear. Business ownership: it’s crazy man. But we’re on the ride and it’s time to stop being lazy. I’m a hustler in the best sense of the word. I know how to pivot and I know how to aim and direct money. I’ve wasted so much money in the past but I’ve made a hell of a lot too! So, to pivot. Pivot is in process. We’re still on the rollercoaster but, at 51 years old, I feel like my days of being in the craziest coasters are coming to an end and the days of being on a more stable, and older person appropriate coaster are just beginning. Stay tuned. You literally never know what’s going to happen around here from week to week.

Item #1 Our first one today is called, “”Questions Swirl Around Screening for Multiple Cancers With a Single Blood Test” by Rubin et. al. and published in JAMA on March 15, 2024

Remember, the citations can be found at chiropracticforward.com under this episode.

Rubin R. Questions Swirl Around Screening for Multiple Cancers With a Single Blood Test. JAMA. 2024;331(13):1077–1080. doi:10.1001/jama.2024.1018

New Blood Tests Promise Early Cancer Detection, But Experts Urge Caution Multiple cancer detection (MCD) blood tests are emerging as a potential way to catch cancer early. However, there’s significant uncertainty surrounding their benefits and drawbacks. What are MCD tests? These tests analyze blood for circulating tumor cells, DNA fragments, proteins, or other indicators suggesting cancer somewhere in the body. Unlike traditional cancer screenings (e.g., mammograms), MCD tests are not specific to one type of cancer and can potentially detect over 50 different cancers.

Pros:

• May detect cancers not covered by existing screening methods.
• Potentially leads to earlier diagnosis and treatment.
• Easier and less invasive than traditional screenings.

Cons:

• Tests are not yet FDA-approved and lack long-term data on effectiveness.
• Positive results may lead to unnecessary anxiety and invasive follow-up procedures.
• Tests might not detect slow-growing cancers or those unlikely to cause harm.
• Unclear if early detection through MCD tests translates to lower cancer mortality.
• High cost not currently covered by insurance.

Unanswered Questions:

• Do MCD tests improve cancer survival rates?
• Do they detect cancers best left untreated?
• How should positive results be interpreted and followed up on?
• Are physicians prepared to guide patients through MCD testing?

The Takeaway: While MCD tests hold promise, their true value remains unclear. Experts recommend waiting for more research before widespread adoption. The focus should be on establishing clear guidelines for appropriate use and interpreting test results.

Item #2

Our second paper today is called, “Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty” by Fenton et. al. and published in Spine Journal in October of 2023 and it’s all hot this week!

Fenton, Joshua J. MD, MPHa,b; Fang, Shao-You PhDb; Ray, Monika PhDb,c; Kennedy, John CCS, CDIPb; Padilla, Katrine MPPb; Amundson, Russell MDd; Elton, David DCd; Haldeman, Scott DC, MD, PhDe; Lisi, Anthony J. DCf; Sico, Jason MD, MHSf,g; Wayne, Peter M. PhDh; Romano, Patrick S. MD, MPHb,c. Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty. Spine 48(20):p 1409-1418, October 15, 2023. | DOI: 10.1097/BRS.0000000000004781

Why They Did It Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.. The authors wantedtTo compare utilization patterns for patients with new-onset neck pain by initial provider specialty.

How They Did It

• Retrospective cohort study.
• De-identified administrative claims and electronic health record data were derived from the Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients representing a mixture of ages and geographical regions across the United States.
• Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty.
• Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.

What They Found

• The cohort included 770,326 patients with new-onset neck pain visits.
• The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%).
• Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty.
• Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty.
• While uncommon after initial visits with chiropractors (≤2%), CT, or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists.
• Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injections and major surgery, respectively, compared with 0.4% and 0.1% of patients initially seen by a chiropractor.

Wrap It Up

Within a large national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared with patients initially seen by physician providers, patients treated initially by chiropractors or therapists received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

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Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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