title: Predictors of imaging surveillance for surgically treated early-stage lung cancer.
abstract: BACKGROUND
  Current guidelines recommend routine imaging surveillance for patients with non-small cell lung cancer (NSCLC) after treatment. Little is known about surveillance patterns for patients with surgically resected early-stage lung cancer in the community at large. We sought to characterize surveillance patterns in a national cohort.
  
  
  METHODS
  We conducted a retrospective study using the Surveillance, Epidemiology, and End-Results (SEER)-Medicare database (1995-2010). Patients with stage I/II NSCLC treated with surgical resection were included. Our primary outcome was receipt of imaging between 4 and 8 months after the surgical procedure. Covariates included demographics and comorbidities.
  
  
  RESULTS
  Chest radiography (CXR) was the most frequent initial modality (60%), followed by chest computed tomography (CT) (25%). Positron emission tomography (PET) was least frequent as an initial imaging modality (3%). A total of 13% of patients received no imaging within the initial surveillance period. Adherence to National Comprehensive Cancer Network (NCCN) guidelines for imaging by overall prevalence was 47% for receipt of CT; however, rates of CT increased over time from 28% to 61% (p < 0.01). Reduced rates of CT were associated with stage I disease and surgical resection as the sole treatment modality.
  
  
  CONCLUSIONS
  Imaging after definitive surgical treatment for NSCLC predominantly used CXR rather than CT. Most of this imaging is likely for surveillance, and in that context CXR has inferior detection rates for recurrence and new cancers. Adherence to guideline-recommended CT surveillance after surgical treatment is poor, but the reasons are multifactorial. Efforts to improve adherence to imaging surveillance must be coupled with greater evidence demonstrating improved long-term outcomes.
authors.affiliation: Surgery Service, VA Puget Sound Health Care System, Seattle, Washington; Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington. Electronic address: lbackhus@u.washington.edu.
authors.forename: Leah M
authors.initials: LM
authors.lastname: Backhus
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Varghese
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Larry
authors.initials: L
authors.lastname: Kessler
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D003952:Diagnostic Imaging / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018426:SEER Program; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014861:Washington / Q000453:epidemiology