Reliance on PET to Detect Lung or Esophageal Cancer Recurrence May Lead to Overuse of the Imaging Modality
In posttreatment follow-up of lung and esophageal cancer, PET scans might be overused to detect cancer recurrence, a recent study published in the Journal of the National Cancer Institute has shown. Furthermore, these results suggest PET scan use to detect recurrence does not increase survival.1
The study, led by Mark Healy, MD, resident, Department of Surgery and Center for Healthcare Outcomes and Policy at the University of Michigan, Ann Arbor, evaluated national Surveillance, Epidemiology, and End Results (SEER) and Medicare-linked data.
The data used were from patients with primary lung or esophageal cancer diagnosed between 2005 and 2009 (n=101 598), with follow-up care continuing to 2011. Lung or esophageal cancer data were used as these cancers have similar anatomic positions and generally poor prognoses for patients.
This study used tumor characteristics to calculate 2-year overall survival. PET use was examined from Medicare claims. After excluding scans obtained for staging and follow-up CT findings, the researchers found significant variation in use of PET scans among hospitals.
In spite of the variation in PET scan use, the differences did not correlate with any differences in survival. Two-year survival was 29.0% for patients with lung cancer at the hospitals with the highest use of PET scans, which was not different from the 2-year survival of patients at hospitals with the lowest use of PET scans (28.8%, P=.66). Similarly, in patients with esophageal cancer, 2-year survival at hospitals with the highest use was 28.4% and 30.3% at hospitals with the lowest use (P=.55).
“Despite statistically significant variation in use of PET to detect tumor recurrence, there was no association with improved 2-year survival. These findings suggest possible overuse of PET for recurrence detection, which current Medicare policy would not appear to substantially affect,” concluded the authors.
"This combination of hospital-based variation without survival benefit suggests potential overuse, and efforts to decrease such overuse are warranted. Providers must take note of available data when making clinical imaging decisions to avoid unnecessary overuse."
1. Healy MA, Yin H, Reddy RM, Wong SL. Use of positron emission tomography to detect recurrence and associations with survival in patients with lung and esophageal cancers [published online ahead of print February 22, 2016]. J Natl Cancer Inst. doi:10.1093/jnci/djv429.