Disparities Exist for Access to PET Scans for NSCLC

Medicare beneficiaries with non-small cell lung cancer didn’t receive equal access to PET scans, as fewer scans are done on patients who are older, black, or who live in less educated or economically advantaged areas of the country, according to a study published in the journalRadiology.

Researchers from Duke University explored demographic and regional factors associated with the use of PET in patients with non-small cell lung cancer (NSCLC) between 1998, when PET won Medicare reimbursement, and 2007.

The cohort included 46,544 patients who had a total of 46,935 cases of NSCLC. They were categorized as early (1998 to 2000), middle (2001 to 2004) and late (2005 to 2007) PET adoption cohorts.

The researchers found that by 2005, more than half of the patients had undergone at least one PET scan, regardless of race, age, education, economic, or geographic status. Among all the patients, the number of patients over the age of 80 who underwent PET increased over time, but still the number remained low (22 percent in the late cohort versus 13 percent in the early cohort), as did the number of patients from predominantly black communities (23 percent in the late cohort versus 15 percent in the early cohort). However, fewer patients without comorbid decisions underwent PET scans in the late cohort compared to the early (48 percent versus 56 percent).

“Patients who underwent PET were more likely to be married, nonblack, and younger than 80 years old, and to live in census tracts with higher education levels or in the Northeast,” wrote the authors.

Distance also played a role in PET scan access. Before 2007, patients who lived more than 40 miles from a PET facility were less likely to have a scan, but this difference was not seen in the late cohort.

A difference was also found between patients who underwent PET scans before treatment. More patients who underwent surgery (79 percent) had a scan before treatment, compared with 63 percent who had chemotherapy, 73 percent who had radiation, and 45 percent who had no treatment at all.

The authors concluded, “PET imaging among Medicare beneficiaries with NSCLC was initially concentrated among nonblack patients younger than 81 years. Despite widespread adoption among all subgroups, differences within demographic subgroups remained.”