Reducing unnecessary fluid testing could lower cancer care costs

by Cedars-Sinai Medical Center

edited by Sadie Harley, reviewed by Robert Egan

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Doctors might be able to safely reduce health care costs by skipping unnecessary laboratory tests for patients with advanced gynecologic cancers, according to a Cedars-Sinai Health Sciences University study. The paper, published in JAMA Network Open, examined testing on fluid drained from the abdomen or around the lungs.

Patients with advanced gynecologic cancer often experience fluid buildup in these areas. Draining the fluid helps relieve pain, pressure and other symptoms, but the investigators found that laboratory testing of the fluid is frequently unnecessary.

Dr. Yingao Zhang, a Cedars-Sinai gynecologic oncology fellow, and Dr. Olivia Foy, an obstetrics and gynecology resident, are co-first authors of the study.

"We undertook this study to determine how often unnecessary tests may be safely skipped, and to estimate how much this would help reduce health care costs," Zhang said.

Testing often added little value

Investigators reviewed 976 fluid-drainage procedures performed on patients with gynecologic cancer at one hospital over 10 years. Laboratory testing was ordered in 40% of cases, a common practice used to rule out infection, check for the presence of cancer cells and determine the cause of fluid buildup.

Nearly 80% of those orders included at least one test the researchers determined was likely unnecessary—either because a cancer diagnosis had already been confirmed or a patient had no symptoms that would prompt further fluid testing. The estimated cost of these tests was roughly $1 million over 10 years.

Where unnecessary orders were concentrated

The investigators found that unnecessary tests were more likely to be ordered in the emergency department or for hospitalized patients than in outpatient clinics. They also found that non-oncology care providers were more likely to order unneeded fluid tests than oncologists.

"Avoiding automatic lab testing on fluid from patients with known cancer diagnoses represents a low-risk opportunity to reduce health care costs," Foy said.

The investigators identified clinician education as a way to reduce unnecessary testing and related costs and suggested that similar analyses in other cancer types and institutions could uncover additional cost-reducing opportunities.

Publication details

Yingao Zhang et al, Cost Analysis and Resource Utilization of Gynecologic Cancer-Related Thoracenteses and Paracenteses, JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.24257

Journal information: JAMA Network Open

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OncologyObstetrics & gynecology Provided by Cedars-Sinai Medical Center Who's behind this story?

Sadie Harley

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