Among patients with early non-small cell lung cancer, researchers observed low adherence to imaging surveillance guidelines after the end of therapy.

“Understanding practice patterns is important, as it allows us to identify sub-populations that may have disparities in receipt of care,” Dejana Braithwaite, PhD, MSc, notes. “Imaging surveillance has been recommended as a routine follow up for patients with non-small cell lung cancer (NSCLC) for quite some time, yet there are still many patients who do not receive this crucial care.”

Patients who undergo routine surveillance are more likely to experience earlier identification of recurrence or second malignancies, “which can potentially be treated with curative intent,” Dr. Braithwaite says. “However, those who do not have routine surveillance are more likely to have recurrence or second malignancies go unnoticed until they have reached an advanced stage.”

For a study presented at the 2023 annual meeting of the American Association for Cancer Research, Dr. Braithwaite and colleagues examined adherence to guideline-recommended imaging surveillance, as well as factors associated with adherence in this population. The researchers utilized the SEER database, pulling data from 2003 to 2016 for patients aged 65-85 with stage 1/2 NSCLC who survived for more than 2 years after completing treatment and had surgical resection or stereotactic body radiotherapy as the primary therapy. Receipt of guideline-directed imaging surveillance was defined as at least one CT or chest X-ray during the following time periods after the end of therapy: 90-270 days, 360-450 days, 540-630 days, and 720-810 days.

Adherence to Imaging Surveillance Guidelines

The analysis included 14,296 patients (57.9% male; 85.8% non-Hispanic White). Less than a quarter of patients (21.9%) received guideline-directed imaging surveillance during the 2-year follow-up period.

“We observed very poor adherence to imaging surveillance guidelines, with less than a quarter of the study participants considered to be adherent for the first 2 years of follow-up after completing lung cancer treatment,” Dr. Braithwaite says. “Adherence within the first year of follow-up was better, but still low.”

The study team identified patient- and treatment-related factors associated with receipt of guideline-recommended surveillance during that 2-year period, including being married (OR, 1.17; 95% CI, 1.06-1.29), receiving neoadjuvant systemic therapy (OR, 1.76; 95% CI, 1.12-2.76), and a Charlson comorbidity score of greater than or equal to three (OR, 1.17; 95% CI, 1.03-1.33). They also determined factors associated with not receiving guideline-recommended imaging surveillance, including non-Hispanic Black race (OR, 0.73; 95% CI, 0.59-0.91) and receipt of adjuvant systemic therapy (OR, 0.68; 95% CI, 0.57-0.81), adjuvant radiotherapy (OR, 0.50; 95% CI, 0.40-0.61), or stereotactic body radiotherapy alone (OR, 0.74; 95% CI, 0.63-0.87).

Strategies Needed to Improve Imaging Surveillance

Overall, the researchers observed low adherence to guideline-recommended imaging surveillance after treatment with curative intent in NSCLC. They also noted the need for strategies to improve compliance to imaging surveillance.

“When looking at patient characteristics associated with receipt of guideline-adherent imaging surveillance, we found that Non-Hispanic Black patients and patients who reside in areas with low socioeconomic status were the least likely to be adherent,” Dr. Braithwaite says. “Our findings highlight that there is a significant need to improve adherence to guideline recommended lung cancer follow up care, particularly among Black communities and patients residing in areas of lower socioeconomic status.”