Chicago, IL—The use of costly diagnostic imaging of uncertain value is increasing rapidly for patients with localized non–small-cell lung cancer (NSCLC), according to data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Frequent surveillance imaging was found for white patients and for those with higher socioeconomic status, despite lack of evidence for its value and its high cost, said Jason D. Wright, MD, Assistant Clinical Professor of Gynecologic Oncology, Columbia University, New York, at ASCO 2013.
Computed tomography (CT) screening of high-risk individuals has led to an increase in the diagnosis and treatment of early-stage tumors, which is then followed by surveillance. “Despite the increasing number of cancer survivors, there are little evidence-based data to guide surveillance strategies,” said Dr Wright.
Guidelines from the National Comprehensive Cancer Network suggest continued surveillance after tumor diagnosis, including a CT scan every 6 to 12 months, and then annually. Positron emission tomography (PET) and magnetic resonance imaging (MRI) are not routinely indicated. Lacking evidence, most of these recommendations are based on expert opinion, he noted.
For patients in remission, the goals of surveillance are to detect recurrent disease and second primary tumors, and to facilitate access to care for other chronic diseases. “The goal of the analysis was to capture testing for patients without recurrent disease,” Dr Wright said.
This study evaluated records from the SEER-Medicare database of patients with stage I or stage II NSCLC who underwent curative surgical resection from 2000 to 2007. Three periods after cancer-directed surgery (6-18 months, 18-30 months, and 30-42 months) were examined.
A separate analysis was performed to examine high-intensity surveillance, defined as at least 1 advanced imaging test (ie, CT, MRI, or PET) during each surveillance period.
The 6 to 18 months postsurgery use of high-cost chest CT climbed from 48% in 2000 to 78% in 2007 and PET use increased from 2% to 23%, whereas the use of chest radiography and bone scanning decreased over time. Similar trends were noted for the other 2 surveillance periods. MRI was used infrequently throughout the study.
“The average cost of surveillance testing during period 1 increased from $397 in 2000 to a peak of $1080 in 2005, and then decreased slightly to $878 in 2007,” said Dr Wright. “Similar trends were noted for subsequent surveillance periods.”
Among 5269 patients who were included in the analysis of high-intensity surveillance, 21.0% diagnosed in 2000 had at least 1 high-cost surveillance test annually; this increased to 47.7% in patients who were diagnosed in 2006.
In addition, patients with high socio-economic status were more likely to undergo annual surveillance imaging; Hispanics and older patients were less likely to undergo testing.