Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.
JAMA Otolaryngol Head Neck Surg. 2021 Jul 1;147(7):632-637. doi: 10.1001/jamaoto.2021.0835.
The National Comprehensive Cancer Network recommends imaging within 6 months after treatment for head and neck cancer (HNC). Further imaging is recommended only if the patient has symptoms or abnormal findings on physical examination. However, in many instances, asymptomatic patients continue to have imaging evaluations.
To assess practice patterns in surveillance imaging in patients with HNC and evaluate the costs associated with these imaging practices.
DESIGN, SETTING, AND PARTICIPANTS: This single-institution retrospective economic evaluation study screened 435 patients to identify patients newly diagnosed with head and neck mucosal and salivary gland malignant tumors between January 1, 2010, and December 31, 2016. Data analyses were performed from October 25, 2018, to November 24, 2020.
Imaging practice patterns.
Number and costs of imaging studies during the surveillance period for all patients, patients who remained disease free, and patients who developed recurrence.
A total of 136 patients (mean [SD] age at diagnosis, 62 [14] years; 84 [61.8%] male; 106 [77.9%] White) with HNC were included in the study. The oropharynx was the most common subsite (64 [47.1%]), most HNCs were stage IVA (62 [45.6%]), and most patients received definitive radiation-based treatment (71 [52.2%]). During the median surveillance period of 3.2 years (range, 0.3-6.8 years), a mean (SD) of 14 (10) imaging studies were performed for all patients, with a mean (SD) total cost of $36 800 ($24 500). In patients who remained disease free, a mean (SD) of 13 (10) imaging studies were performed during the surveillance period, with a mean (SD) total cost of $35 000 ($21 700). Patients who lacked symptoms had a mean (SD) of 4 (3) studies performed per year, resulting in a mean cost of $9600 ($5900) per year. Patients who developed recurrence had more studies per year of follow-up (mean difference, 5.0; 95% CI, 3.4-6.6) and higher associated mean costs (mean difference, $10 600; 95% CI, $6100-$15 000) than patients who remained disease free.
In this economic evaluation study, many patients treated for HNCs received imaging studies beyond what is recommended by National Comprehensive Cancer Network guidelines. These findings suggest that the cost burden of imaging in the asymptomatic patient needs to be considered against the value obtained from routine imaging in this current health care environment.
重要性：美国国家综合癌症网络建议在头颈部癌症（HNC）治疗后 6 个月内进行影像学检查。只有当患者出现症状或体格检查异常时，才建议进一步进行影像学检查。然而，在许多情况下，无症状患者仍继续进行影像学评估。
目的：评估 HNC 患者监测成像中的实践模式，并评估这些成像实践相关的成本。
设计、地点和参与者：这项单机构回顾性经济评估研究对 435 例患者进行了筛查，以确定 2010 年 1 月 1 日至 2016 年 12 月 31 日期间新诊断为头颈部黏膜和唾液腺恶性肿瘤的患者。数据分析于 2018 年 10 月 25 日至 2020 年 11 月 24 日进行。
暴露：成像实践模式。
主要结局和措施：所有患者、无疾病患者和复发患者在监测期间的影像学研究数量和成本。
结果：共纳入 136 例 HNC 患者（诊断时平均[标准差]年龄，62[14]岁；84[61.8%]男性；106[77.9%]为白人）。最常见的部位是口咽（64[47.1%]），最常见的 HNC 分期为 IVA 期（62[45.6%]），大多数患者接受了确定性的基于放疗的治疗（71[52.2%]）。在中位随访期 3.2 年（范围，0.3-6.8 年）中，所有患者平均（标准差）进行了 14（10）次影像学检查，总费用为 36800 美元（24500 美元）。在无疾病的患者中，监测期间平均（标准差）进行了 13（10）次影像学检查，总费用为 35000 美元（21700 美元）。无症状患者每年平均进行 4（3）次检查，每年的平均费用为 9600 美元（5900 美元）。与无疾病患者相比，复发患者每年的检查次数更多（平均差异，5.0；95%CI，3.4-6.6），相关的平均费用更高（平均差异，10600 美元；95%CI，6100-15600 美元）。
结论：在这项经济评估研究中，许多接受 HNC 治疗的患者接受了超出美国国家综合癌症网络指南推荐的影像学检查。这些发现表明，在当前的医疗保健环境下，需要考虑无症状患者的影像学检查成本与其常规影像学检查所带来的价值。
