Barriers to surveillance imaging adherence in early-staged lung cancer

Abstract

Background: Frequency of post-treatment surveillance is highly variable following curative resection of non-small cell lung cancer (NSCLC). We sought to characterize surveillance practices after lobectomy for early-stage NSCLC and to identify the impact of various demographic factors on patterns of surveillance. Methods: We included patients who underwent anatomic lobectomy for pathologic stage I NSCLC from 2007-2017. Demographic characteristics, post-operative imaging studies (internal and external), and travel distance were recorded. We defined the minimal standard of surveillance imaging studies (MSSIS) as ≥7 studies in the first 5 years (computed tomography/positron emission tomography). Patient sex, ethnicity, marital status, and distance traveled were evaluated as predictors of imaging receipt. Standard descriptive statistics, univariate, and multivariate analysis (MVR) were performed. Results: A total of 1,288 patients were included. The mean age was 65.5±10.1 years, 589 (45.7%) were male, 1,081 (83.9%) were Caucasian, and 924 (71.7%) were married. Only 464 (36%) achieved MSSIS;being married [75.6% (351/464) vs. 68.8% (567/824), P=0.01] and having larger tumor size (2.63±0.04 vs.2.49±0.05 cm, P=0.03) were both associated with MSSIS. Patients residing <100 miles from the hospital were more likely to have MSSIS, and more imaging at 24 months (4.1±2.2 vs. 3.7±2.0; P=0.006), 60 months (8.0±5.1 vs. 6.6±4.2, P=0.001) and overall (10±7.3 vs. 8.2±6.3; P=0.001). On MVR, tumor size and marital status were associated with MSSIS. Conclusions: Two-thirds of patients at our institution did not undergo recommended surveillance imaging. Tumor size, being married, and living <100 miles from the medical center were associated with an increased number of imaging studies and greater adherence to guidelines.

Association between travel distance and overall survival among patients with adrenocortical carcinoma

“…However, regionalization of care may come at a price 13–19 . Patients who must travel long distances to high‐volume, regional referral centers for surgery are unlikely to receive surgery if they are unable or unwilling to travel—in this study, rural patients treated close to home (<4.4 miles, the lowest quintile), were less likely to receive surgery than their metropolitan counterparts.…”

The Use of Imaging Tests for the Diagnosis and Management of Lung Nodules

“…However, according to Erb et al, the adherence to available guidelines for surveillance was poor: fewer than twothirds of patients received recommended imaging, and almost 30% received non-recommended PET scans (74). Previous evidence also showed that over a third of the 1,200 patients who underwent lobectomy for pathologic stage I NSCLC, received minimal expected imaging studies for surveillance in the first five years after surgery (75).…”

On the road again: Impact of travel distance on outcomes for lung cancer

“… 4 Within our cohort, travel distance was similarly shown to have a detrimental impact on the likelihood of undergoing appropriate postoperative therapy. We selected a threshold of travel >100 miles based on previous work by Bostock and colleagues, 5 which revealed the negative impact of travel distance on adherence to recommended postoperative surveillance imaging in NSCLC, and found that traveling >100 miles also led to substantially reduced likelihood of receiving indicated adjuvant surveillance (odds ratio, 0.13; 95% confidence interval, 0.06-0.26, P < .001). 4 …”