Increasing use of positron emission tomography among medicare beneficiaries undergoing radical cystectomy

• Published in: European journal of cancer care Vol. 29; no. 4; pp. e13230 - n/a
• Main Authors: Maganty, Avinash, Turner, Robert M., Yabes, Jonathan G., Heron, Dwight E., Gingrich, Jeffrey R., Davies, Benjamin J., Jacobs, Bruce L.
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.07.2020
• Subjects: Alkaline phosphatase; Bladder; Bladder cancer; Cancer; Chemotherapy; Government programs; Health risks; Health services; health services research; Histology; Identification methods; Invasiveness; Logit models; Mathematical analysis; Medicare; Muscles; neoplasm staging; Nursing; Patients; Positron emission; Positron emission tomography; SEER; Service areas; Surgeons; Surgery; Tomography; health services research; SEER; neoplasm staging; positron emission tomography; bladder cancer; medicare
• ISSN: 0961-5423; 1365-2354
• DOI: 10.1111/ecc.13230

Objective To examine factors associated with PET scan use in the pre‐operative evaluation of patients diagnosed with bladder cancer. Methods Using SEER‐Medicare data, we identified bladder cancer patients who underwent radical cystectomy from 2006 to 2011 (n = 4,138). The primary outcome was PET scan use within 6 months before surgery. To examine predictors of PET scan use, we fit a mixed logit model with health service area as a random effect to account for patients nested within health service areas. We also calculated the adjusted probability of use over time and examined variation among the highest volume surgeons. Results Among the 4,138 patients, 406 (10%) received a pre‐operative PET scan. The adjusted probability of a patient undergoing a PET scan increased from 0.04 in 2004 to 0.10 in 2011 (p < .001). Among the 78 highest volume surgeons, there was significant variation in PET scan use (p < .001). Patients with non‐urothelial histology, measurement of alkaline phosphatase levels, and receipt of neoadjuvant chemotherapy were more likely to receive PET scan (all p < .05). Conclusion Use of PET prior to radical cystectomy doubled over a 5‐year period, suggesting its increased use in patients with muscle‐invasive bladder cancer, particularly those with high‐risk disease. Whether its use is warranted and improves patient outcomes is not clear and requires further studies.