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Original Research: Lung Cancer |

Facility-Level Analysis of PET Scanning for Staging Among US Veterans With Non-small Cell Lung CancerEffectiveness of PET Scan for Lung Cancer Staging

Michael K. Gould, MD, FCCP; Todd H. Wagner, PhD; Ellen M. Schultz, MS; Xiangyan Xu, MS; Sharfun J. Ghaus, MBBS; Dawn Provenzale, MD; David H. Au, MD; for the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium
Author and Funding Information

From the Department of Veterans Affairs (Dr Gould), VA Palo Alto Health Care System (Drs Wagner and Ghaus), Palo Alto, CA; VA Health Economics Research Center (Dr Wagner), Menlo Park, CA; Center for Primary Care and Outcomes Research (Ms Schultz), Stanford University, Stanford, CA; Palo Alto Institute for Research and Education (Ms Xu), Palo Alto, CA; Durham Epidemiologic Research and Information Center (Dr Provenzale), Durham VA Medical Center, Durham, NC; Duke University (Dr Provenzale), Durham, NC; Health Services Research and Development Service (Dr Au), VA Puget Sound Health Care System, Seattle, WA; and Department of Medicine (Dr Au), University of Washington, Seattle, WA.

Correspondence to: Michael K. Gould, MD, FCCP, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101; e-mail: michael.k.gould@kp.org


Dr Gould is presently at the Department of Research and Evaluation, Kaiser Permanente Southern California (Pasadena, CA).

Part of this article has been presented at the American Thoracic Society International Conference, May 14-19, 2010, New Orleans, LA.

Funding/Support: This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research, and Health Services Research and Development Services [CRS 02-164 and HSR 05-101] and the National Cancer Institute [U01 CA93324, U01 CA93326, U01 CA93329, U01 CA93332, U01 CA93339, U01 CA93344, and U01 CA93348].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):839-847. doi:10.1378/chest.13-1073
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Background:  PET scanning has been shown in randomized trials to reduce the frequency of surgery without cure among patients with potentially resectable non-small cell lung cancer (NSCLC). We examined whether more frequent use of PET scanning at the facility level improves survival among patients with NSCLC in real-world practice.

Methods:  In this prospective cohort study of 622 US veterans with newly diagnosed NSCLC, we compared groups defined by the frequency of PET scan use measured at the facility level and categorized as low (< 25%), medium (25%-60%), or high (> 60%).

Results:  The median age of the sample was 69 years. Ninety-eight percent were men, 36% were Hispanic or nonwhite, and 54% had moderate or severe comorbidities. At low-, medium-, and high-use facilities, PET scan was performed in 13%, 40%, and 72% of patients, respectively (P < .0001). Baseline characteristics were similar across groups, including clinical stage based on CT scanning. More frequent use of PET scanning was associated with more frequent invasive staging (P < .001) and nonsignificant improvements in downstaging (P = .13) and surgery without cure (P = .12). After a median of 352 days of follow-up, 22% of the sample was still alive, including 22% at low- and medium-use facilities and 20% at high-use facilities. After adjustment and compared with patients at low-use facilities, the hazard of death was greater for patients at high-use facilities (adjusted hazard ratio [HR], 1.35; 95% CI, 1.05-1.74) but not different for patients at medium-use facilities (adjusted HR, 1.14; 95% CI, 0.88-1.46).

Conclusions:  In this study of veterans with NSCLC, markedly greater use of PET scanning at the facility level was associated with more frequent use of invasive staging and possible improvements in downstaging and surgery without cure, but greater use of PET scanning was not associated with better survival.

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