Follow-up Imaging and Survival in Head and Neck Cancer Patients Open Access

Shah, Priti Prakash (2017)

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An important part of post-diagnosis follow-up care for head and neck cancers (HNC) is surveillance imaging aimed at early detection of disease recurrence. This study investigates if imaging initiated at least 6 months post- diagnosis of HNC leads to better overall survival. The data for the analyses were obtained from the Surveillance Epidemiology and End Results (SEER)-Medicare Linkage file. The main independent variable in this analysis was time-dependent. The person time intervals that included imaging by X-ray, computed tomography (CT) and/or positron emission tomography (PET) were considered exposed. The outcome, disease-specific survival, was ascertained during the follow-up and was used as a proxy for HNC recurrence. A total of 14,936 patients diagnosed with HNC between 1992 and 2007 were included in the study and contributed 100,988 person- months of follow up. After adjusting for relevant covariates using a time-dependent extended Cox model, the rate of cancer-specific death following imaging was 2.58 times higher (95% confidence interval: 2.38-2.79) than the corresponding rate without imaging. These findings indicate that post-diagnosis imaging among HNC patients, as documented in Medicare claims, is likely performed for clinical rather than surveillance reasons. A proper analysis of the association between surveillance imaging and disease prognosis requires more detailed information about indications for testing among asymptomatic patients. Imaging in the current analysis is probably a surrogate for disease severity and/or recurrence.

Table of Contents

1. Chapter I: Background

2. Chapter II: Manuscript

a. Title, Authors, Abstract

b. Introduction

c. Methods

d. Results

e. Discussion

f. References

g. Tables

h. Figure

3. Chapter III: Summary, Public Health Implications, Possible Future Directions

4. Appendices

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