What Are the Costs Associated With Imaging Surveillance After Treatment for Head and Neck Cancer?

Study findings suggest that many patients with head and neck cancers received imaging beyond what is recommended by the National Comprehensive Cancer Network (NCCN) guidelines, and the cost burden of imaging asymptomatic patients needs to be considered (JAMA Otolaryngol Head Neck Surg. 2021;147[7]:632-637. doi:10.1001/jamaoto.2021.0835).

“The National Comprehensive Cancer Network recommends imaging within 6 months after treatment for head and neck cancer,” explained Cheryl C. Nocon, MD, Department of Surgery, Pritzker School of Medicine, The University of Chicago, Illinois, and colleagues.

“Further imaging is recommended only if the patient has symptoms or abnormal findings on physical examination. However, in many instances, asymptomatic patients continue to have imaging evaluations,” they continued.

This study aimed to assess practice patterns in surveillance imaging among patients with head and neck cancer, as well as the costs associated with surveillance imaging.

Patients with newly diagnosed head and neck mucosal and salivary gland malignant tumors between January 2010 and December 2016 were included in the study. Data analyses were performed from October 25, 2018 to November 24, 2020.

A total of 136 patients were identified and included in the economic evaluation. During the median surveillance period of 3.2 years, a mean of 14 imaging studies were performed for all patients with a mean total cost of $36,800.

In patients who remained disease-free, a mean of 13 imaging studies were performed during the surveillance period, with a mean total cost of $35,000. In patients who were asymptomatic, a mean of 4 imaging studies were performed per year with a mean total cost of $9600 per year.

Patients with recurrent disease had more studies per year of follow-up (mean difference, 5) and higher associated mean costs (mean difference, $10,600) than those who remained disease-free.

“In this economic evaluation study, many patients treated for HNCs received imaging studies beyond what is recommended by [NCCN] guidelines. These findings suggest that the cost burden of imaging in the asymptomatic patient needs to be considered against the value obtained from routine imaging in this current health care environment,” concluded Dr Nocon and colleagues.—Janelle Bradley