Is PET overused in detection of cancer recurrence in lungs, esophagus?

New research has uncovered a broad utilization gap between the lowest and highest hospital-based users of PET to detect cancer recurrence, with no gains in two-year survival to justify the procedure at the higher end of the usage range.

The combination may spell an overall case of overutilization, according the authors of a study published Feb. 22 in JNCI: Journal of the National Cancer Institute.

Mark Healy, MD, University of Michigan, and colleagues examined the national Surveillance, Epidemiology, and End Results (SEER) and Medicare-linked data of a nationally representative cohort—101,598 patients—with primary lung and esophageal cancers from 2005 to 2009, with follow-up through 2011.

Homing in on lung and esophageal cancers due to those diseases’ similarly poor diagnoses and general anatomic locations, they found that lowest vs. highest utilizing hospitals performed .05 vs. 0.70 scans per person-year for lung cancer and 0.12 vs. 0.97 scans per person-year for esophageal cancer.

Despite the scope of the difference in utilization, the outcomes were closely similar.

For patients undergoing PET, lowest vs. highest utilizing hospitals had an adjusted two-year survival of 29 percent vs. 28.8 percent for lung cancer and 28.4 percent vs. 30.3 percent for esophageal cancer.

Meanwhile, in something of an enlightening aside, the researchers found that more PET scans were performed on stage IV patients, for both cancers, than on any other staged group.

This may suggest an unnecessarily aggressive better-safe-than-sorry stance among providers caring for patients in advanced stages of cancer.

“Overuse of tests, specifically PET for detection of tumor recurrence after initial treatment, has [previously] been raised as a concern, especially in patients with poor prognosis cancers,” Healy et al. point out.

In their discussion, the authors state that the combination of hospital-based variation without survival benefit suggests potential overuse.

Thus, they write, “efforts to decrease such overuse are warranted.”

The authors further note that Medicare’s current policy limits routine reimbursement to three scans—a policy meant to guide subsequent management after completion of initial cancer therapy.

“Our findings highlight patterns of variation in the use of PET to detect tumor recurrence without clear benefit in long-term patient outcomes,” they write, “which would not appear to be affected substantially by current Medicare policy.”