Association of Receipt of Positron Emission Tomography-Computed Tomography with Non-Small Cell Lung Cancer Mortality in the Veterans Affairs Health Care System

Abstract

Importance: Positron emission tomography-computed tomography (PET-CT) has been increasingly used in the management of lung cancer, but its association with survival has not been convincingly documented. Objective: To examine the association of the use of PET-CT with non-small cell lung cancer (NSCLC) mortality in the US Department of Veterans Affairs (VA) health care system from 2000 to 2013. Design, Setting, and Participants: This cohort study included 64103 veterans receiving care in the VA health care system who were diagnosed with incident NSCLC between September 2000 and December 2013. Data analysis took place in October 2018. Exposure: Use of PET-CT before and/or after diagnosis. Main Outcomes and Measures: All-cause and NSCLC-specific 5-year mortality; secondary outcome was receipt of stage-appropriate treatment. Results: A total of 64103 veterans with the diagnosis of NSCLC were evaluated; 62838 (98.0%) were men, and 50584 (78.9%) were white individuals. Among these, 51844 (80.9%) had a PET-CT performed: 25735 (40.1%) in the 12 months before diagnosis and 41242 (64.3%) in the 5 years after diagnosis. Increased PET-CT use (597 of 978 veterans [59.2%] in 2000 vs 3649 of 3915 [93.2%] in 2013) and decreased NSCLC-specific 5-year mortality (879 of 978 veterans [89.9%] in 2000 vs 3226 of 3915 veterans [82.4%] in 2013) were found over time. Increased use of stage-appropriate therapy was also seen over time, from 346 of 978 veterans (35.4%) in 2000 to 2062 of 3915 (52.7%) in 2013 (P