Surveillance Imaging in Head, Neck Cancer Remission

Core Concepts

Routine surveillance imaging post head and neck cancer remission does not improve survival rates and can lead to unnecessary procedures.

Abstract

TOPLINE:

• Routine surveillance imaging post head and neck cancer remission does not improve survival.
• More false positives and unnecessary procedures result from routine imaging.

METHODOLOGY:

• Surveillance imaging in head and neck cancer remission is debated.
• Study compared outcomes in 340 adults with negative PET scans post-treatment.
• 55% had imaging-based surveillance, 45% clinically-based.
• No significant difference in outcomes between the two groups.

TAKEAWAY:

• No difference in local-regional control, overall survival, progression-free survival, or freedom from distant metastases between imaging-based and clinically based surveillance.
• Positive predictive value of biopsies was 49% in imaging group and 89% in clinical group.
• Neck dissection rate higher in surveillance arm.

IN PRACTICE:

• Routine imaging of asymptomatic patients in remission from head and neck cancers should be discouraged.
• High rates of false-positive tests are concerning.

SOURCE:

• Study led by Allen Chen, MD, published in JAMA Network Open.

LIMITATIONS:

• Not a randomized trial.
• HPV status imbalance between groups could affect outcomes.

DISCLOSURES:

• No external funding or relevant financial relationships reported.

Stats

Overall, 51 recurrences occurred among all 340 patients, 32 in the imaging-based surveillance group and 19 in the clinically based surveillance group.
Positive predictive value of biopsies was 49% in the imaging surveillance group and 89% in the clinical surveillance group.
Neck dissection rate was 9% in the surveillance arm vs 2% in the clinical management arm.

Quotes

"The results of the present study, while seemingly paradoxical, are consistent with those of others which have failed to demonstrate a benefit to surveillance imaging among patients who have successfully completed treatment for head and neck cancer."
"These findings suggest that the routine imaging of asymptomatic patients in remission from head and neck cancers should be discouraged."

Key Insights Distilled From

Surveillance Imaging After Head, Neck Cancer Remission?

by M. Alexander... at www.medscape.com 11-15-2023

https://www.medscape.com/viewarticle/998502

Deeper Inquiries

What are the potential implications of discouraging routine surveillance imaging in head and neck cancer remission?

Discouraging routine surveillance imaging in head and neck cancer remission could have several implications. Firstly, it may lead to a reduction in unnecessary procedures and interventions for patients who are asymptomatic. This can help in avoiding the physical, emotional, and financial burden associated with false-positive results and subsequent biopsies or treatments. Additionally, by reducing the number of false positives, healthcare resources can be allocated more efficiently to those who truly need them, improving overall healthcare system effectiveness. However, there may be concerns about potentially missing early signs of recurrence in some patients, which could impact their outcomes if not detected promptly.

Could there be situations where routine imaging might still be beneficial despite the study's findings?

While the study suggests that routine surveillance imaging in head and neck cancer remission may not provide a survival benefit and can lead to more false positives, there could still be situations where routine imaging might be beneficial. For instance, in patients with a high risk of recurrence based on specific tumor characteristics or treatment history, regular imaging could be warranted to detect any signs of recurrence early. Additionally, in cases where patients have persistent symptoms or concerning physical exam findings, imaging may be necessary to rule out recurrence promptly. It is essential for healthcare providers to individualize care and consider the unique circumstances of each patient when determining the need for surveillance imaging.

How can healthcare providers balance patient demands for imaging with the risks of false positives and unnecessary procedures?

Healthcare providers can balance patient demands for imaging with the risks of false positives and unnecessary procedures by engaging in shared decision-making with patients. It is crucial to educate patients about the limitations and potential harms of routine surveillance imaging, including the risk of false positives and unnecessary interventions. Providers can discuss the rationale behind their recommendations and involve patients in the decision-making process, taking into account their preferences and concerns. By fostering open communication and shared decision-making, healthcare providers can help patients understand the implications of imaging surveillance and make informed choices that align with their values and goals of care. Additionally, ongoing patient education and communication can help manage expectations and address any anxieties or uncertainties related to surveillance imaging.