Lack of adherence to guideline-based imaging prior to subsequent radiation in patients with non-small cell lung cancer: Impact on patient outcomes

Abstract

Lung cancer is the leading cause of cancer deaths within the United States, yet prior studies have shown a lack of adherence to imaging and treatment guidelines in patients with lung cancer. This paper evaluates the use of FDG PET/CT imaging prior to subsequent radiation therapy in patients with non-small cell lung cancer, as recommended by National Comprehensive Cancer Network (NCCN) guidelines, and whether the use of this imaging modality impacts cancer-specific survival. Methods: This was a retrospective study of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program Medicare linked data in patients with non-small cell lung cancer. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and cancer-specific survival were estimated for patients diagnosed between 2006-2015 who underwent either FDG PET/CT or CT based imaging prior to subsequent radiation therapy. Results: Significant improvement in cancer-specific survival was found in patients who had FDG PET/CT imaging prior to subsequent radiation therapy, compared to those who underwent CT (HR, 1.43; 95% CI, 1.32-1.55, P <0.0001). While the NCCN recommends FDG PET/CT prior to subsequent radiation therapy, 43.6% of patients were imaged with CT alone. Conclusion: Many patients with non-small cell lung cancer are not being imaged according to national guidelines prior to subsequent radiation, which is associated with a lower cancer specific survival.