Ketan Shah1, Luc Te Marvelde2, Marnie Collins2, Richard De Abreu Lourenco3, Ieta D'Costa4, Andrew Coleman4, Tsien Fua4, Chen Liu4, Danny Rischin5, Eddie Lau6, June Corry4. 1. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Electronic address: ketan.shah@doctors.org.uk. 2. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 3. Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, Sydney, Australia. 4. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 5. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 6. Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Prognostic information can rationalise clinical follow-up after radical cancer treatment. This retrospective cohort study of radical head and neck (chemo)radiotherapy patients examines the clinical safety and cost implications of stratifying follow-up intensity by post-treatment (18)FDG-PET-CT response. METHODS: In 2008 clinical review after radical head and neck radiotherapy was reduced from 3- to 6-monthly for patients with complete (18)FDG-PET-CT response at 3months. 184 patients treated after this change ("PET Stratified", 2009-11) were compared to 178 patients treated before ("Standard", 2005-7). Clinical safety was assessed by the time to detection of recurrence, overall survival and potential for radical treatment of recurrence. A hospital cost analysis was performed using individual patient data. RESULTS: 127 of 178 Standard and 148 of 184 PET Stratified patients achieved complete response on post-treatment imaging. Baseline clinical characteristics were comparable. Median follow-up from response assessment was 4.8years in the Standard cohort and 2.1years for PET Stratified. PET Stratified patients had a mean 4.4 outpatient visits in 2years, compared to 7.0 among Standard patients. Over 90% of patients remained free of recurrence at 2years in both cohorts. Time to detection of recurrence was similar between two cohorts (HR1.05, 95%CI 0.45-2.52), as was overall survival (HR0.91, 95%CI 0.36-2.29). The proportion of radically treatable recurrences was also similar (42% Standard vs. 47% PET Stratified). The hospital cost savings per patient from reduced review were AUD$2606 over 2years, AUD$5012 over five. CONCLUSION: (18)FDG-PET-CT to stratify follow-up intensity after radical radiotherapy for head and neck cancer reduces costs with no apparent clinical detriment.
BACKGROUND: Prognostic information can rationalise clinical follow-up after radical cancer treatment. This retrospective cohort study of radical head and neck (chemo)radiotherapy patients examines the clinical safety and cost implications of stratifying follow-up intensity by post-treatment (18)FDG-PET-CT response. METHODS: In 2008 clinical review after radical head and neck radiotherapy was reduced from 3- to 6-monthly for patients with complete (18)FDG-PET-CT response at 3months. 184 patients treated after this change ("PET Stratified", 2009-11) were compared to 178 patients treated before ("Standard", 2005-7). Clinical safety was assessed by the time to detection of recurrence, overall survival and potential for radical treatment of recurrence. A hospital cost analysis was performed using individual patient data. RESULTS: 127 of 178 Standard and 148 of 184 PET Stratified patients achieved complete response on post-treatment imaging. Baseline clinical characteristics were comparable. Median follow-up from response assessment was 4.8years in the Standard cohort and 2.1years for PET Stratified. PET Stratified patients had a mean 4.4 outpatient visits in 2years, compared to 7.0 among Standard patients. Over 90% of patients remained free of recurrence at 2years in both cohorts. Time to detection of recurrence was similar between two cohorts (HR1.05, 95%CI 0.45-2.52), as was overall survival (HR0.91, 95%CI 0.36-2.29). The proportion of radically treatable recurrences was also similar (42% Standard vs. 47% PET Stratified). The hospital cost savings per patient from reduced review were AUD$2606 over 2years, AUD$5012 over five. CONCLUSION: (18)FDG-PET-CT to stratify follow-up intensity after radical radiotherapy for head and neck cancer reduces costs with no apparent clinical detriment.
Authors: Sweet Ping Ng; Courtney Pollard; Joel Berends; Zeina Ayoub; Mona Kamal; Adam S Garden; Houda Bahig; Scott B Cantor; Andrew J Schaefer; Temitayo Ajayi; G Brandon Gunn; Steven J Frank; Heath Skinner; Jack Phan; William H Morrison; Renata Ferrarotto; Jason M Johnson; Abdallah S R Mohamed; Stephen Y Lai; Amy C Hessel; Erich M Sturgis; Randal S Weber; Clifton D Fuller; David I Rosenthal Journal: Cancer Date: 2019-02-12 Impact factor: 6.860
Authors: Finbar Slevin; Ekin Ermiş; Sriram Vaidyanathan; Mehmet Sen; Andrew F Scarsbrook; Robin Jd Prestwich Journal: Clin Med Insights Oncol Date: 2017-06-14
Authors: Melvin L K Chua; Daniel J Ma; Carryn M Anderson; Sana D Karam; Danielle N Margalit; Randall J Kimple Journal: Adv Radiat Oncol Date: 2020-05-15