M. A. Healy1, H. Yin1, R. M. Reddy1, S. L. Wong1 1University Of Michigan,Department Of Surgery And Center For Health Outcomes & Policy,Ann Arbor, MI, USA
Introduction: Positron Emission Tomography (PET) scans are commonly used for cancer patients as part of the staging process. PET scans are often used for surveillance without evidence that they are superior to lower cost screening scans, and there are concerns about potential overuse. We evaluated PET utilization patterns for patients with lung (LC) and esophageal (EC) cancers.
Methods: Using national Surveillance Epidemiology and End Results (SEER) and Medicare linked data from 2005-2009, we examined the use of PET in a cohort of patients with primary lung (n=105,697) and esophageal (n=6,961) cancers who were diagnosed during this period. Cancer diagnoses were identified with ICD-9 diagnoses codes: lung 162.xx and esophagus 150.xx. Diagnostic services such as PET are captured as charges, which are covered under Medicare. We examined a fee-for-service cohort of patients, excluding patients in risk-bearing Medicare managed care plans and patients who are not continuously enrolled in parts A and B. We examined the frequency and timing of PET usage, including with regard to diagnosis, treatment and cancer stage.
Results: There was similar overall utilization of PET in these groups, with 47,795 (45.2%) and 3,734 (53.6%) of lung and esophageal cancer patients, respectively, receiving at least one scan. Most patients received a first scan within 3 months of diagnosis (78.3% LC, 87.3% EC), indicating likely use for staging. Use of 2 or more scans occurred in 20,216 (19.1%) and 1,867 (26.7%) of LC and EC patients, respectively. Additionally, 11,117 (10.5%) LC and 1,052 (15.1%) EC patients underwent 3 or more scans. Among patients with stage IV disease, 2 or more scans were performed in 4,987 (11.8%) and 382 (21%) of LC and EC patients, respectively. In this stage IV group, 2,710 (6.4%) LC and 222 (12.2%) EC underwent 3 or more scans.
For patients who underwent PET prior to chemotherapy, 10,085 (28.5%) and 781 (26.8%) of LC and EC patients received a single additional scan, 11,467 (32.3%) and 1,345 (46.2%) had 2 or more scans, and 6,774 (19.1%) and 793 (27.2%) had 3 or more scans. Total PET usage for LC was 96,475 scans and for EC was 8,223 scans.
Conclusion: Our results show that PET usage is common, though only half of patients with LC and EC received staging scans. However, many patients undergo multiple scans. A large number of patients with stage IV disease underwent as many as 3 or more scans, and it is in these patients that the likelihood of any benefit is the least. Our data supports the need for continued education to avoid using PET for surveillance in these cancers, especially in patients with advanced disease. Medicare’s current policy limiting routine reimbursement to 3 scans probably does not effectively curb wasteful PET usage.