Disparities based on age, race persist in PET use for lung cancer patients

Demographic differences in the use of PET imaging among Medicare beneficiaries with non-small cell lung cancer (NSCLC) have persisted since the modality’s approval by Medicare in 1998, according to a study published online Feb. 15 in Radiology.

“Despite widespread adoption of PET overall, patients who were older, black, or from less educated or more impoverished census tracts had lower PET use that persisted through 2007, with an absolute rate of PET use approximately 10 percentage points lower in each group,” wrote authors Michaela A. Dinan, PhD, of the Duke Clinical Research Institute in Durham, N.C., and colleagues.

Findings were based on a retrospective analysis of the Surveillance Epidemiology and End Results Medicare data for patients given a diagnosis of NSCLC between 1998 and 2007. A total of 46,544 patients were included in the final study cohort.

By 2005, more than half of all patients underwent one or more PET examinations, reported the authors. However, multivariable logistic regression analysis revealed that patients who were married, nonblack, younger than 80 years and living in areas of higher education levels or in the Northeast were more likely to undergo PET imaging.

“Providers should be mindful that PET is not uniformly administered to all patient populations,” wrote the authors.

Dinan et al also reported that PET imaging rates were growing rapidly in the South in addition to the Northeast, and that distance from a PET facility is not as strongly associated with lower access as it once was. Only 4 percent of patients were located more than 40 miles from a PET facility by the end of the study period.

Possible explanations for the disparities in PET use include availability of the technology, cost, physician preference and patient preference, speculated Dinan and colleagues. Racial differences in PET utilization are likely linked to treatment, they explained. Racial differences nearly disappeared when limited to patients who underwent surgery. In patients who underwent surgery, PET was used prior to treatment in 79.2 percent of cases, compared with 63.4 percent, 72.5 percent and 44.6 percent in patients undergoing chemotherapy, radiation therapy or no treatment, respectively.

“The possibility that racial variation in receipt of PET may be associated with surgery is supported by previous studies of health disparities in NSCLC that have suggested that disparities in race and age were driven by access to surgery,” wrote the authors.

The authors concluded by noting that differential adoption of emerging medical technologies has previously been implicated in disparities in disease management, and that the effect of unequal adoption of PET on patient care is an important area of research.

“Regardless of the true benefit of PET, our study demonstrates that PET use did not spread equitably in the population of Medicare beneficiaries with NSCLC and that this unintended discrepancy in care persisted despite high overall rates of adoption.”