Lung Cancer Survivors Receive Too Many PET Scans

Lung and esophageal cancer survivors undergo excessive positron emission tomography (PET) scans during follow-up care with no impact on survival, claims a new study.

Researchers at the University of Michigan (U-M; Ann Arbor, USA), and Dartmouth-Hitchcock Medical Center (Lebanon, NH, USA) searched the US Surveillance, Epidemiology, and End Results (SEER) register to identify 97,152 primary lung and 4,446 esophageal cancer patients with follow-up data, using patient and tumor characteristics to calculate risk-adjusted two-year overall survival. Using Medicare claims, they then examined PET utilization in person-years, excluding scans for staging and for follow-up of CT findings, and stratified hospitals by quintiles of PET utilization for adjusted two-year survival analysis.

The results showed a statistically significant variation in utilization of PET scans, ranging from 0.05 to 0.70 scans per person-year for lung cancer and 0.12 to 0.97 scans per person-year for esophageal cancer. But despite the statistically significant variation in use of PET to detect tumor recurrence, there was no association with improved two-year survival, suggesting possible overuse of PET for recurrence detection, which current Medicare policy would not appear to substantially affect. The study was published on February 22, 2016, in the Journal of the National Cancer Institute.

“PET scanning is a great technology and very effective, but using it in this way doesn't seem to make any difference for these cancers that have a relatively poor prognosis,” said lead author Mark Healy, MD, of U-M. “Following evidence-based guidelines for clinical follow-up is the way to go; don't order PET in asymptomatic patients. And for patients, if you are not having symptoms and you're doing well, there's no reason to seek out this scan.”

PET scans are often used for staging, restaging, and monitoring of cancer patients for treatment response. They are also often used to detect recurrence in asymptomatic patients, despite a lack of evidence demonstrating improved survival. The US Centers for Medicare & Medicaid Services (CMS; Baltimore, MD, USA) impose a limit of three follow-up PET scans per person, even when doctors only order them following a computerized tomography (CT) or other medical imaging procedure.

Related Links:
University of Michigan
Dartmouth-Hitchcock Medical Center
The US Centers for Medicare & Medicaid Services