SESSION TITLE: Lung Cancer Treatment & Outcomes
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Surveillance positron emission tomography (PET) imaging following curative intent treatment of non-small cell lung cancer (NSCLC) is not supported by available evidence. ASCO and ABIM's joint Choosing Wisely campaign recommends against surveillance PET, yet the frequency with which PET imaging is performed during surveillance care is unknown. We aimed to describe trends in PET use among patients with Stage I-IIIA NSCLC following surgical resection.
METHODS: Patients aged 66+ and diagnosed with stage I-IIIA NSCLC in 2001-2009, who underwent surgical resection were identified in SEER-Medicare data. Eligibility for surveillance started 180 days post-operatively. Use of imaging was assessed during the first year of surveillance and classified as 1) Any-PET: receipt of PET or integrated PET/CT regardless of other imaging, or 2) PET-only: receipt of PET or integrated PET/CT only, in patients who did not undergo separate dedicated chest CT imaging. Proportions of patients receiving each category of PET imaging were adjusted for patient age, sex, race/ethnicity, marital status, Charlson comorbidity index, and ZIP-Code-level median household income in 2000, and then calculated by diagnosis year and stage. Equality of proportions was assessed between diagnosis years with ANOVA tests.
RESULTS: 7,393 NSCLC patients met inclusion criteria. 79% had Stage I NSCLC, 13% Stage II, and 9% Stage IIIA disease. Any-PET use more than doubled over the study period. 11% of all NSCLC patients diagnosed in 2001 received any-PET vs. 25% diagnosed in 2009 (P < 0.001). PET utilization was more common in higher stage NSCLC patients, and increased significantly between 2001 and 2009. In Stage IIIA NSCLC patients diagnosed in 2001, 14% received any-PET compared to 41% diagnosed in 2009 (P = 0.004). PET-only use also increased significantly, more than tripling over the study period. 3% of all NSCLC patients diagnosed in 2001 received PET-only vs. 10% diagnosed in 2009 (P<0.001). Among Stage IIIA patients, 1% diagnosed in 2001 received PET-only, compared to 15% diagnosed in 2009 (P=0.014).
CONCLUSIONS: Although not indicated in surveillance, PET utilization has more than doubled among NSCLC survivors over the study period.
CLINICAL IMPLICATIONS: While surveillance rates may be increasing generally, increased rates of PET-only imaging suggest PET is inappropriately replacing existing surveillance protocols.
DISCLOSURE: Anil Vachani: Grant monies (from industry related sources): Allegro Diagnostics, Grant monies (from industry related sources): Integrated Diagnostics, Grant monies (from industry related sources): Janssen Research & Development, Consultant fee, speaker bureau, advisory committee, etc.: Allegro Diagnostics (SAB) ended Sept 2014 The following authors have nothing to disclose: Christine Ciunci, Christine Veenstra, Hanna Zafar, E. Carter Paulson, Andrew Epstein
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