The Use of Expensive Scans in Lung and Esophageal Cancer Survivors

Nationally there is a wide variation between hospitals using positron emission tomography (PET) scans for follow-up care for survivors of lung and esophageal cancers. An analysis found many hospitals are using the test inappropriately as a primary way to monitor cancer survivors.

The findings, published in the Journal of the National Cancer Institute, also found that using the costly PET scans to monitor these patients’ condition did not help them survive longer. PET scans are not recommended as the first option for long-term monitoring to watch for cancer recurrence. Medicare imposes limits (3 follow-up scans per person), even when PET scans are ordered after suspicious findings on a CT scan or other image.

“The appropriate use of PET scanning in follow-up care for lung and esophageal cancer is after findings on lower-cost imaging options,” co-author Mark Healy, MD, of the University of Michigan Department of Surgery, said in a statement.

The study found that more than 22% of the lung cancer patients and 31% of the esophageal cancer patients had at least one PET scan to check for recurrence during their follow-up period, without first having a CT scan or other imaging. The variation between hospitals’ use of PET scans were wide. Some nearly never used it, and some used PET scans a majority of time. Some hospitals used PET scans 8 times more often than others did.

Overall, patients who went to a hospital that used PET scans frequently for lung cancer follow-up were just as likely to survive 2 years as those who went to a hospital with low use of PET scans, reported Sandra L. Wong, MD, MS, of the University of Michigan Medical School, and colleagues. The researchers examined Medicare data for more than 100,000 lung and esophageal cancer patients from hundreds of hospitals nationwide who had cancer in the mid-2000s and follow-up care through 2011.

The authors hope their findings will help providers of all kinds understand the best use of PET scanning in cancer care.

“Following evidence-based guidelines for clinical follow-up is the way to go,” Dr Healy said. “Don’t order PET in asymptomatic patients.”