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Less frequent CT scans may reduce healthcare costs and patient anxiety
Regular post-surgical screening is essential for patients with lung cancer, the second most common type of cancer in the United States and the leading cause of cancer death. In cases involving early-stage non-small cell lung cancer, up to half of patients will experience a recurrence within the first two years after surgery.
For these reasons, guidelines from the National Comprehensive Cancer Network and other cancer control groups recommend computed tomography (CT) scans every three to six months for patients whose malignant lung tumors have been surgically removed. However, a new study by researchers at Washington University School of Medicine in St. Louis found no improvement in survival or recurrence rates in patients who followed the protocol, compared to those who were scanned. every six months to a year.
“Our results suggest that treatment guidelines for lung cancer should consider less frequent surveillance imaging than current recommendations,” said study lead author Varun Puri, MD, thoracic surgeon and professor of surgery. “Annual monitoring would simplify guidelines and could result in better and easier postoperative care for patients at an early stage. »
The study is published Nov. 28 in the Journal of the National Cancer Institute.
Non-small cell lung cancer accounts for 84% of all lung cancer cases, according to the American Cancer Society, and the overall five-year survival rate is 25%.
The researchers focused on the first two years after surgery since that is when the risk of lung cancer recurring is highest. After two to three years, cancer organizations generally recommend annual scans until the end of life.
“Scanning too frequently may be associated with unnecessary patient anxiety and increased health care costs,” said Puri, also a research fellow at the Siteman Cancer Center at Washington University School of Medicine and Barnes- Jewish Hospital. “Patients who receive scans to check for recurrent cancer are naturally anxious, especially since it can take several days for the results to be received. This phenomenon is sometimes called ‘scananxiety’. It is obviously important to minimize the scanxie when it can be done safely.
For the study, the researchers analyzed anonymized medical records in a database maintained by the US Veterans Health Administration, the nation’s largest integrated health care delivery system. Researchers reviewed information for 6,171 patients with stage 1 non-small cell lung cancer who underwent surgery from October 1, 2006 to September 31, 2016. One group of patients received scans every three at six months, and the other group every six months. at 12 months.
In any case, more examinations did not improve health, including among different tumor sizes, tumor stages, and types of surgical procedures. Recurrence was observed in 22% of patients and did not differ according to examination frequency. Similarly, overall survival remained the same between the two groups, with approximately 65% of patients surviving at least five years.
The average patient age was 67.5 years. Patients were predominantly male and white; however, statistical modeling controlled for different ages, genders, and races.
“We found that some patients received more frequent CT scans, including patients who smoked and patients who had had certain types of operations,” said study first author Brendan Heiden, MD, a resident of surgery and researcher at the University of Washington. “Conversely, we found that African American patients received less frequent scans, which is a potentially concerning health disparity that warrants further research. Nevertheless, we were encouraged to find that patient results were generally equivalent regardless of examination frequency. »
Heiden continued, “The VA treats a unique patient population that consists primarily of men with a significant smoking history. Therefore, we believe that our results apply especially to veterans with lung cancer. However, previous studies examining non-VA patient populations have found results similar to ours, suggesting that the findings may apply more broadly to the general population. More research is needed.
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