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Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 140 kB

Date submitted: June 01, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
For patients with breast, colorectal, and lung cancers, what is the comparative effectiveness for improving net health outcome of more versus less frequent follow-up imaging to monitor for recurrence or disease progression?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
yes
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
1. Frequency of Computerized Tomography (CT) scans for colorectal cancer
2. Frequency of Positron Emission Tomography (PET) for lung cancer
3. Frequency of 18F-fluoro-deoxy-glucose (FDG-PET) scans or Magnetic Resonance Imaging (MRI) for breast cancer
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Adults with breast, colorectal cancer, or lung cancer having undergone primary treatment
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
• Patients who have had local or regional therapy (with or without adjuvant therapy) with no evidence of disease and are monitored for recurrence
• Patients treated with a first-line regimen for more advanced (incurable) disease and are monitored for disease progression
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
More frequent imaging might detect recurrence or progression sooner, leading to earlier treatment or earlier changes in treatment, which might be more effective and thus improve overall, disease-free or progression-free survival and quality of life.
Describe any health-related risks, side effects, or harms that you are concerned about.
Risk of radiation exposure and unnecessary biopsies with more frequent imaging; increased toxicities from starting or changing chemotherapy too soon (false positive results); potentially reduced quality of life if time between therapies is shortened and earlier treatment is not effective.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
yes
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Cancer
AHRQ Priority Populations
  • Women
  • Elderly
Federal Health Care Program
  • Medicaid
  • Medicare

Importance

Describe why this topic is important.
Breast, colorectal, and lung cancers are among the most common malignancies. Tumor recurrence is common following surgical resection for the primary cancers, depending in part on the specific cancer and stage at diagnosis. Survival following loco-regional or distant recurrence is generally poor and there is an elevated risk of secondary malignancies. Follow-up imaging may detect these new cancers, possibly allowing early, definitive therapy. There is, however, uncertainty about how often to undergo imaging for disease recurrence or progression. There are also the added inconvenience and costs, as well as radiation exposure associated with some imaging modalities, associated with more frequent imaging.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
This topic was given high priority by a multi-disciplinary stakeholder panel (including patient advocates/representatives) convened to identify and select important research questions on cancer amenable to systematic and comparative effectiveness reviews. There is substantial variability among physicians, institutions, and practice settings in how often they monitor patients and in the imaging modalities used. This has implications for both quality of care and costs.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
yes
If yes, please explain:
There is uncertainty about how often to recommend imaging for disease recurrence or progression. The usefulness of routine imaging for surveillance after surgery is debated.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
A report would inform clinical decision-making for patients, payers and providers.
Describe the timeframe in which an answer to your question is needed.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Patients for whom access to healthcare is more difficult, either financially or
physically, e.g., rural populations, the frail elderly, and low income groups, may not
receive follow-up imaging as often as other cancer patients following primary therapy.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Other
Are you making a suggestion as an individual or on behalf of an organization?
Organization - BlueCross BlueShield Association Technology Evaluation Center
Please tell us how you heard about the Effective Health Care Program
The BlueCross BlueShield Association Technology Evaluation Center is an Evidence-based Practice Center of AHRQ.