Trends in the Use of (18)F-Fluorodeoxyglucose PET Imaging in Surveillance of Non-Small-Cell Lung and Colorectal Cancer

Abstract

Purpose: Surveillance PET after curative-intent treatment of non-small-cell lung cancer (NSCLC) or colorectal cancer (CRC) is not clearly supported by available evidence or the Choosing Wisely campaign. However, the frequency of PET imaging during the surveillance period is relatively unknown.

Methods: Using Surveillance, Epidemiology, and End Results-Medicare data, 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 were identified. Trends in "any PET" or "PET-only" use 6 to 18 months postoperatively were assessed.

Results: Any PET use more than doubled over the study period. Eleven percent of patients with NSCLC and 4% of those with CRC diagnosed in 2001 received any PET, compared with 25% of patients with NSCLC and 13% of those with CRC in 2009 (P < .001 for both). Higher stage disease was correlated with higher PET utilization and faster growth in use over the study period. PET-only use also increased over the study period, especially in higher stage disease. Fewer than 2% of patients diagnosed with stage IIIA NSCLC in 2001 received PET only, compared with 15% of patients diagnosed in 2009 (P = .014). Similarly, 1% of patients diagnosed with stage III CRC in 2001 received PET only, compared with 8% of patients diagnosed in 2009 (P < .001).

Conclusions: PET utilization during the surveillance period increased between 2001 and 2009. Further research is needed to determine the factors driving use of surveillance PET and to examine relationships between PET and patient outcomes.

Keywords: Choosing Wisely; FDG-PET; Positron emission tomographic imaging; colorectal cancer; non–small-cell lung cancer; surveillance.

Figure 1.. Adjusted PET Surveillance in Non-Small Cell Lung Cancer, by Disease Stage, 2001–2009

Models adjust for patient age, sex, race/ethnicity, marital status, Charlson comorbidity index, and ZIP-Code level median household income in 2000. In these stacked area graphs, the red crosshatches indicate “PET only” and the blue stripes indicate PET with additional imaging. Their sum indicates “any PET.”

Figure 2.. Adjusted PET Surveillance in Colorectal Cancer, by Disease Stage, 2001–2009

Models adjust for patient age, sex, race/ethnicity, marital status, Charlson comorbidity index, and ZIP-Code level median household income in 2000. In these stacked area graphs, the red crosshatches indicate “PET only” and the blue stripes indicate PET with additional imaging. Their sum indicates “any PET.”