Use of Imaging During Staging and Surveillance of Localized Colon Cancer in a Large Insured Population

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Background: Adherence to surveillance guidelines in resected colon cancer has significant implications for patient morbidity, cost of care, and healthcare utilization. This study measured the underuse and overuse of imaging for staging and surveillance in stage I–II colon cancer. Methods: The OptumLabs database was queried for administrative claims data on adult patients with stage I–II colon cancer who underwent surgery alone in 2008 through 2016. Use of PET and CT imaging was evaluated during both initial staging (n=6,921) and surveillance for patients with at least 1 year of follow-up (n=5,466). “High use” was defined as >2 CT abdominal/pelvic (CT A/P) or PET scans per year during surveillance. Results: Overall, 27% of patients with stage I–II colon cancer did not have a staging CT A/P or PET scan and 95% did not have a CT chest scan. However, rates of staging CT A/P and CT chest scans increased from 62.0% (2008) to 74.8% (2016) and from 2.3% (2008) to 7.1% (2016), respectively. Staging PET use was overall very low (5.2%). During surveillance, approximately 30% of patients received a CT A/P or PET and 5% received a CT chest scan within the first year after surgery. Of patients who had surveillance CT A/P or PET scans, the proportion receiving >2 scans within the first year (high use) declined from 32.4% (2008) to 9.6% (2016) (P = .01). Conclusions: Although PET use remains appropriately low, many patients with stage I–II colon cancer do not receive appropriate staging and surveillance CT chest scans. Among those who do receive these scans during surveillance, high use has declined significantly over time.

Submitted February 19, 2019; accepted for publication April 29, 2019.Author contributions: Study concept: Durani, Halfdanarson, Thompson, Peethambaram, Quevedo, Go. Funding acquisition: Go. Formal analysis: Asante, Heien. Methodology: Durani, Asante, Heien, Sangaralingham, Go. Supervision: Go. Manuscript preparation: Durani. Review and editing: Asante, Halfdanarson, Heien, Sangaralingham, Thompson, Peethambaram, Quevedo, Go.Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.Funding: This study was made possible by a “Transform the Practice” grant from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Go).Correspondence: Ronald S. Go, MD, Division of Hematology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email: go.ronald@mayo.edu

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