Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_39_2985 - Overuse of Diagnostic Brain Imaging among patients with Stage IA Non-Small Cell Lung Cancer

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Overuse of Diagnostic Brain Imaging among patients with Stage IA Non-Small Cell Lung Cancer
M. Milligan1, A. M. Cronin2, L. Li2, Y. Colson3, K. Kehl2, and A. B. Chen4; 1Harvard Medical School, Boston, MA, 2Dana-Farber Cancer Institute, Boston, MA, 3Brigham and Women's Hospital, Boston, MA, 4Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Purpose/Objective(s): Among patients diagnosed with Stage IA non-small cell lung cancer (NSCLC), the incidence of a clinically occult brain metastasis is less than 2%, and brain imaging prior to definitive treatment may be costly and lead to delays in care. As such, Choosing Wisely guidelines from the Society of Thoracic Surgeons have recommend against the practice. This study sought to characterize the use of brain imaging at the time of diagnosis among Medicare patients with Stage IA NSCLC.

Materials/Methods: Using data from Surveillance, Epidemiology, and End-Results (SEER) linked to Medicare claims, we identified patients diagnosed with Stage IA NSCLC (AJCC 7th edition) between 2004 and 2013. We classified patients as receiving brain imaging at diagnosis if they had a head CT with contrast or brain MRI from 1 month prior to 3 months after diagnosis. Multivariable logistic regression was used to identify factors associated with the receipt of brain imaging.

Results: Among 13,809 patients with Stage IA NSCLC, 3,567 (25.8%) received brain imaging in the month preceding or 3 months following diagnosis. Over the study period, the rate of brain imaging increased from 23.5% in 2004 to 28.4% in 2013. We observed significant variation in the use of brain imaging across the 110 hospital service areas (HSAs) that cared for at least 20 patients, with area-specific rates of brain imaging ranging from 0% to 64.0% (median: 23.4%, IQR: 18.3% – 28.2%). Factors associated with a greater likelihood of receiving brain imaging included older age (OR 1.02 per year, p < 0.01), non-white race (OR 1.11, p = 0.02), unmarried relationship status (OR 1.16, p = 0.01), higher modified Charlson comorbidity score (Charlson 2+ vs 0-1, OR 1.11, p < 0.01), and pathologic T1B classification (T1B vs T1A classification, OR 1.25, p < 0.01).

Conclusion: Across the US, roughly 1 in 4 patients with Stage IA NSCLC received brain imaging at the time of diagnosis, and this rate has risen over time, despite national recommendations against the practice. Patients who were older, with more comorbidities, and those with larger primary tumors were more likely to receive brain imaging, and we observed significant geographic variation in rates of brain imaging. Closer adherence to clinical guidelines is likely to result in more cost-effective care.

Author Disclosure: M. Milligan: None. L. Li: None. Y. Colson: None. K. Kehl: None.

Michael Milligan, MD

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