Cancer surveillance PET rises, suggesting overutilization
A robust, population-based study has revealed that, from 2001 through 2009, the use of PET imaging swelled among patients with resected non–small-cell lung cancer (NSCLC) and colorectal cancer (CRC).
The increase occurred both when separate CT imaging was used and when it wasn’t, and the numbers probably point to inappropriate PET utilization as well as inappropriate substitution of PET for guideline-recommended conventional CT.
In presenting the results, the authors of the study noted that neither clinical care guidelines nor the Choosing Wisely campaign supports the use of such surveillance PET imaging after curative intent treatment of NSCLC and CRC.
The study was published online Jan. 14 in JACR.
Christine M. Veenstra, MD, MSHP, of the University of Michigan and colleagues examined Surveillance, Epidemiology, and End Results (SEER)–Medicare data on 65,748 patients aged 66 years or older who were diagnosed with stage I to IIIA NSCLC or stage I to III CRC from 2001 through 2009 and who underwent surgical resection.
They found that overall PET use more than doubled during the study period.
In 2001, 11 percent of patients diagnosed with NSCLC and 4 percent of those diagnosed with CRC diagnosed received any PET. By 2009, overall PET use had risen to 25 percent for patients with NSCLC and to 13 percent for those with CRC.
The researchers recorded a correlation between higher stage disease and higher PET utilization.
They further found that PET-only use increased over the study period, and the growth was especially pronounced in cases involving higher stage disease.
In their discussion section, Veenstra et al. note that Choosing Wisely recommends against surveillance PET—not only because clear benefit hasn’t been shown but also because false-positive results are likely. These, of course, tend to drive pricey and unnecessary follow-up procedures into cancer care.
It’s for these reasons that CMS has not reimbursed surveillance PET since it initiated coverage of this modality in 2001, the authors point out.
“Our findings are important given the health-related and economic costs associated with PET imaging during surveillance,” they write.
The authors call for further research looking into what drives PET imaging during post-treatment surveillance and to carefully examine relationships between surveillance PET and patient outcomes.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.