Follow-up Imaging and Survival in Head and Neck Cancer Patients Pubblico

Abstract

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

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Parola chiave	follow-up imaging survival head and neck cancer
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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