Lung Cancer |

Surveillance Practice Patterns After Curative Intent Therapy for Stage I Non-small Cell Lung Cancer in the Medicare Population FREE TO VIEW

Christopher Erb, PhD; Pamela Soulos; Lynn Tanoue, MD; Cary Gross, MD
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Pulmonary and Critical Care Medicine, Yale University, New Haven, CT

Chest. 2014;146(4_MeetingAbstracts):607A. doi:10.1378/chest.1992085
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 02:45 PM - 04:15 PM

PURPOSE: Non-small-cell lung cancer (NSCLC) remains the leading cause of cancer mortality in the United States, with overall 5-year survival estimated at 18%. Recurrence after curative intent therapy is common, and routine surveillance of NSCLC patients is recommended by evidence-based guidelines. We set out to understand current practice patterns for surveillance of stage I NSCLC in the first two years after curative intent therapy in the Medicare population.

METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, which contains tumor registry data linked to Medicare claims. We selected subjects aged 67 to 94 years who were diagnosed with stage I NSCLC between 1998 and 2009. Based on specialty society recommendations for “best practice”, we defined guideline adherence as the receipt of at least one chest radiograph or computed tomography (CT) scan during each 6-month interval over a 2-year period. We determined the percent of patients receiving guideline-adherent surveillance imaging during each year during the study period.

RESULTS: Our sample included 12,485 patients (mean age 75 years; 55.6% female). The overall 2 and 5-year survival estimates were 81.4% and 52.9%, respectively. Overall, 55.9% of patients received “guideline-adherent” surveillance during the initial 2 years after treatment. This number was stable throughout the study period, ranging from 51% to 60% in any given year. There was an overall increase in the use of CT scans in the first year of surveillance, from 47.4% in 1998-2001 to 78.5% in 2008-2009, and a decrease in use of chest radiograph from 91.3% to 73.6%.

CONCLUSIONS: Adherence to specialty society guidelines for lung cancer surveillance after curative intent therapy was low in this population of Medicare beneficiaries. Further research is needed to determine whether variation in practice patterns and adherence to guidelines affects patient outcomes or the cost of lung cancer care.

CLINICAL IMPLICATIONS: Understanding what factors drive current lung cancer surveillance practice patterns and adherence to clinical practice guidelines is a crucial first step in designing and implementing future practice guidelines. Minimizing the barriers to and leveraging the facilitators of evidence-based lung cancer care will improve patient outcomes and increase the quality and consistency of the care patients receive.

DISCLOSURE: The following authors have nothing to disclose: Christopher Erb, Pamela Soulos, Lynn Tanoue, Cary Gross

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