Matthew C Cheung1, Nicole Mittmann2, Craig C Earle3, Farah Rahman4, Ning Liu4, Simron Singh5. 1. Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: matthew.cheung@sunnybrook.ca. 2. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada. 3. Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 5. Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: The use of surveillance computed tomography (CT) imaging in patients with diffuse large B-cell lymphoma in remission is neither effective nor cost-effective. The American Society of Hematology Choosing Wisely (CW) campaign, in particular, emphasizes the lack of benefit beyond 2 years of completion of therapy. We sought to describe the real-world practice of surveillance imaging. PATIENTS AND METHODS: We used population-based health system administrative databases from Ontario, Canada. We studied a cohort of all adult patients ≥ 18 years with diffuse large B-cell lymphoma who received rituximab (R) with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) between 2004 and 2012. We defined an index date of 2 years after the last dose of RCHOP as the time frame beyond which surveillance imaging would be inappropriate. The cumulative incidence of receiving CT scans after the index date represented the primary outcome of interest. RESULTS: The cohort consisted of 2401 patients treated with RCHOP during the study period. The cumulative incidence reached 52.5% (range, 50.4%-54.6%) by 3 years of follow-up. On multivariable analysis, patients with more comorbidities and within certain geographic regions within the province were noted to have increased CT scanning. The cumulative incidence appeared to decrease over the study follow-up period (from 62.4% in 2006 to 48.0% in 2014; P < .001). CONCLUSION: During a timeframe in which surveillance imaging is deemed unnecessary by the CW campaign, the practice remains excessive. Regional variations in CT scanning suggest that local practice patterns can be targeted to reduce imaging. A recent decline in scanning may reflect a broadening appreciation for the evidence against surveillance or uptake of the CW campaign.
INTRODUCTION: The use of surveillance computed tomography (CT) imaging in patients with diffuse large B-cell lymphoma in remission is neither effective nor cost-effective. The American Society of Hematology Choosing Wisely (CW) campaign, in particular, emphasizes the lack of benefit beyond 2 years of completion of therapy. We sought to describe the real-world practice of surveillance imaging. PATIENTS AND METHODS: We used population-based health system administrative databases from Ontario, Canada. We studied a cohort of all adult patients ≥ 18 years with diffuse large B-cell lymphoma who received rituximab (R) with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) between 2004 and 2012. We defined an index date of 2 years after the last dose of RCHOP as the time frame beyond which surveillance imaging would be inappropriate. The cumulative incidence of receiving CT scans after the index date represented the primary outcome of interest. RESULTS: The cohort consisted of 2401 patients treated with RCHOP during the study period. The cumulative incidence reached 52.5% (range, 50.4%-54.6%) by 3 years of follow-up. On multivariable analysis, patients with more comorbidities and within certain geographic regions within the province were noted to have increased CT scanning. The cumulative incidence appeared to decrease over the study follow-up period (from 62.4% in 2006 to 48.0% in 2014; P < .001). CONCLUSION: During a timeframe in which surveillance imaging is deemed unnecessary by the CW campaign, the practice remains excessive. Regional variations in CT scanning suggest that local practice patterns can be targeted to reduce imaging. A recent decline in scanning may reflect a broadening appreciation for the evidence against surveillance or uptake of the CW campaign.
Authors: David L Chan; Matthew Cheung; Craig C Earle; Natalie Coburn; Nicole Mittmann; Farah Rahman; Ning Liu; Simron Singh Journal: J Gastrointest Cancer Date: 2020-03