A study finding significant variation in the use of positron emission tomography (PET) scans, but no association between the number of scans and improved 2-year survival, suggests that the imaging technique might be overused in patients with lung and esophageal cancers.
PET scans are highly used in most clinical settings for the purposes of staging, restaging, and treatment monitoring in patients with cancer. These tests are expensive, however, and little evidence has been presented to support the use of PET for detecting recurrence in patients with cancer. In fact, the American Society of Clinical Oncology guidelines recommend avoiding PET use for monitoring cancer recurrence. Despite this, a number of institutions continue to use PET for this purpose.
Mark A Healy, MD, University of Michigan (Ann Arbor, MI), and coauthors published a study in Journal of the National Cancer Institute examining the relationship between the utilization of PET for detecting cancer recurrence and survival for patients with lung and esophageal cancers. The researchers identified patient cases from 2005 to 2009 with follow-ups through 2011. In total, they identified 97,152 patients with lung cancer and 4446 patients with esophageal cancer; the median age for both cohorts was 76 years.
The researchers reported that more than 22% of lung cancer patients and 31% of esophageal cancer patients had at least one PET scan to monitor for cancer recurrence during follow-up. Institutions varied greatly in how often they used PET tests for this purpose; whereas some never used the technique, others used it for the majority of patients.
Yet, researchers found no link between PET use and 2-year survival. Likewise, patients who were treated at facilities with high rates of PET use were just as likely to survive 2 years as those who went to a facility with low rates of PET use.
Therefore, researchers concluded that PET scans are likely overused, and measures should be taken to avoid the use of these tests for monitoring in order to reduce unnecessary costs for patients and hospitals.
