Christopher T Erb1, Kevin W Su2, Pamela R Soulos3, Lynn T Tanoue1, Cary P Gross4. 1. Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States. 2. Yale University School of Medicine, New Haven, CT, United States. 3. Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, United States. 4. Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, United States. Electronic address: cary.gross@yale.edu.
Abstract
OBJECTIVES: Recurrence after treatment for non-small cell lung cancer (NSCLC) is common, and routine imaging surveillance is recommended by evidence-based guidelines. Little is known about surveillance patterns after curative intent therapy for early stage NSCLC. We sought to understand recent practice patterns for surveillance of stage I NSCLC in the first two years after curative intent therapy in the Medicare population. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database we selected patients diagnosed with stage I NSCLC between 1998 and 2008. We studied adherence to surveillance guidelines based on specialty society recommendations for chest radiography and computed tomography (CT) scanning. We also tracked the use of Positron Emission Tomography (PET) scans, which are not recommended for surveillance. We calculated the percent of patients who received guideline-adherent surveillance imaging and used logistic regression to determine associations between patient and provider factors and guideline adherence. RESULTS: Overall, 61.4% of patients received guideline-adherent surveillance during the initial 2 years after treatment. Use of CT scans in the first year after treatment increased from 47.4% in 1998-78.5% in 2008, and PET use increased from 5.8% to 28.9%. Adherence with surveillance imaging was associated with younger age, higher income, more comorbidities, access to primary care, and receipt of SBRT as the primary treatment. CONCLUSIONS: Adherence to specialty society guidelines for surveillance after treatment for stage I NSCLC was poor in this population of Medicare beneficiaries, with less than two-thirds of patients receiving recommended imaging, and almost 30% receiving non-recommended PET scans.
OBJECTIVES: Recurrence after treatment for non-small cell lung cancer (NSCLC) is common, and routine imaging surveillance is recommended by evidence-based guidelines. Little is known about surveillance patterns after curative intent therapy for early stage NSCLC. We sought to understand recent practice patterns for surveillance of stage I NSCLC in the first two years after curative intent therapy in the Medicare population. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database we selected patients diagnosed with stage I NSCLC between 1998 and 2008. We studied adherence to surveillance guidelines based on specialty society recommendations for chest radiography and computed tomography (CT) scanning. We also tracked the use of Positron Emission Tomography (PET) scans, which are not recommended for surveillance. We calculated the percent of patients who received guideline-adherent surveillance imaging and used logistic regression to determine associations between patient and provider factors and guideline adherence. RESULTS: Overall, 61.4% of patients received guideline-adherent surveillance during the initial 2 years after treatment. Use of CT scans in the first year after treatment increased from 47.4% in 1998-78.5% in 2008, and PET use increased from 5.8% to 28.9%. Adherence with surveillance imaging was associated with younger age, higher income, more comorbidities, access to primary care, and receipt of SBRT as the primary treatment. CONCLUSIONS: Adherence to specialty society guidelines for surveillance after treatment for stage I NSCLC was poor in this population of Medicare beneficiaries, with less than two-thirds of patients receiving recommended imaging, and almost 30% receiving non-recommended PET scans.
Authors: Mary Beth Landrum; Nancy L Keating; Elizabeth B Lamont; Samuel R Bozeman; Barbara J McNeil Journal: Cancer Date: 2011-11-09 Impact factor: 6.860
Authors: Gregory S Cooper; Christine Cole Johnson; Lois Lamerato; Laila M Poisson; Lonni Schultz; Jan Simpkins; Karen Wells; Marianne Ulcickas Yood; Gary Chase; S David Nathanson; Jennifer Elston Lafata Journal: Med Care Date: 2006-06 Impact factor: 2.983
Authors: C A Angeletti; A Mussi; A Janni; M Lucchi; A Ribechini; A Chella; G Fontanini Journal: Eur J Cardiothorac Surg Date: 1995 Impact factor: 4.191
Authors: Amrit Bhaskarla; Paul C Tang; Terry Mashtare; Chukwumere E Nwogu; Todd L Demmy; Alex A Adjei; Mary E Reid; Sai Yendamuri Journal: J Surg Res Date: 2010-01-25 Impact factor: 2.192
Authors: Michaela A Dinan; Lesley H Curtis; William R Carpenter; Andrea K Biddle; Amy P Abernethy; Edward F Patz; Kevin A Schulman; Morris Weinberger Journal: J Clin Oncol Date: 2012-07-02 Impact factor: 44.544
Authors: Shrujal S Baxi; Minal Kale; Salomeh Keyhani; Benjamin R Roman; Annie Yang; Antonio P Derosa; Deborah Korenstein Journal: Med Care Date: 2017-07 Impact factor: 2.983
Authors: Ian C Bostock; Wayne Hofstetter; Reza Mehran; Ravi Rajaram; David Rice; Boris Sepesi; Stephen Swisher; Ara Vaporciyan; Garrett Walsh; Mara B Antonoff Journal: J Thorac Dis Date: 2021-12 Impact factor: 2.895
Authors: Timothy L McMurry; George J Stukenborg; Larry G Kessler; Graham A Colditz; Melisa L Wong; Amanda B Francescatti; David R Jones; Jessica R Schumacher; Caprice C Greenberg; George J Chang; David P Winchester; Daniel P McKellar; Benjamin D Kozower Journal: Ann Surg Date: 2018-10 Impact factor: 12.969