Predictors of Imaging Surveillance for Surgically Treated, Early-Stage Lung Cancer

Thesis (Master's)--University of Washington, 2014Purpose: Current guidelines recommend routine imaging surveillance for non-small cell lung cancer (NSCLC) patients following treatment. Little is known about surveillance patterns for surgically resected, early-stage lung cancer patients in the community-at-large. We sought to characterize surveillance patterns in a national cohort. Methods: We conducted a retrospective study using 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 following surgery. Covariates included demographics and comorbidities. Results: Chest radiography (CXR) was the most frequent initial modality (60%) followed by chest computerized tomography (CT) (25%). Positron emission tomography (PET) was least frequent as 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 imaging increased over time from 28% to 61% (p