Unnecessary Scans Create Cost Burden for Lung Cancer Patients

PET scans are not recommended for long-term monitoring of cancer recurrence.

Costly PET scans are being used in hospitals to monitor lung cancer survivors, which is inadvertently burning a hole in their pockets and doing little to help with survival, a recent study suggests.

"PET scanning is a great technology and very effective, but using it in this way doesn't seem to make any difference for these cancers that have a relatively poor prognosis," said researcher Mark Healy, MD. "The appropriate use of PET scanning in follow-up care for lung and esophageal cancer is after findings on lower-cost imaging options."

Although PET scans are powerful, they are expensive. These scans allow doctors to see increased activity among cells inside the body, which includes fast-growing cancer cells, early on.

Many patients are given PET scans so doctors can see how far the cancer has advanced and how it’s responding to treatment. However, when it comes to long-term monitoring for cancer recurrence, PET scans are not recommended.

The study, published in the Journal of the National Cancer Institute, sought to evaluate which scanning methods were used to monitor the disease.

Medicare has set limits for the number of PET scans per person. Currently, 3 follow-up PET scans are allowed, including ones that are ordered by doctors after seeing something questionable on a patients CT scan.

The study looked at Medicare data for over 100,000 patients nationwide with lung and esophageal cancer in the mid-2000s, with follow up care through 2011.

The results of the study showed that 31% of esophageal cancer patients and 22% of lung cancer patients had at least 1 PET scan during their follow-up period to spot any cancer recurrence without first using a CT scan or any other imaging device.

Some of the hospitals studied were found to have used the scan 8 times more than other imaging devices.

Lung cancer patients who went to a hospital that frequently used PET scans for their follow-up were found to be just as likely to survive 2 years as patients who went to a low PET use hospital.

"Our work shows that almost no one is getting to the 3-scan limit set by Medicare,” Healy said. “But, with many thousands of patients getting 1 or 2 scans across the whole country, this is still a very large number, with very high costs. If the intention of the policy is to curb overuse, this doesn't seem to be a very effective method, and the agency should reevaluate how it structures its limits."

Researchers believe that improvement in coordination between caregivers after the treatment of their patients could have better effects, and that their findings can help providers and patients better understand the best use of PET scans in cancer care.

"Following evidence-based guidelines for clinical follow-up is the way to go,” Healy said. “Don't order PET in asymptomatic patients. And for patients, if you are not having symptoms and you're doing well, there's no reason to seek out this scan."