Are We Choosing Wisely in Lymphoma? Excessive Use of Surveillance CT Imaging in Patients With Diffuse Large B-cell Lymphoma (DLBCL) in Long-term Remission

Clinical Lymphoma, Myeloma & Leukemia
Matthew C CheungSimron Singh

Abstract

The use of surveillance computed tomography (CT) imaging in patients with diffuse large B-cell lymphoma in remission is neither effective nor cost-effective. The American Society of Hematology Choosing Wisely (CW) campaign, in particular, emphasizes the lack of benefit beyond 2 years of completion of therapy. We sought to describe the real-world practice of surveillance imaging. We used population-based health system administrative databases from Ontario, Canada. We studied a cohort of all adult patients ≥ 18 years with diffuse large B-cell lymphoma who received rituximab (R) with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) between 2004 and 2012. We defined an index date of 2 years after the last dose of RCHOP as the time frame beyond which surveillance imaging would be inappropriate. The cumulative incidence of receiving CT scans after the index date represented the primary outcome of interest. The cohort consisted of 2401 patients treated with RCHOP during the study period. The cumulative incidence reached 52.5% (range, 50.4%-54.6%) by 3 years of follow-up. On multivariable analysis, patients with more comorbidities and within certain geographic regions within the province were noted to have increased CT...Continue Reading

Citations

Oct 19, 2019·Expert Review of Pharmacoeconomics & Outcomes Research·R Andrew HarkinsChristopher R Flowers
Jul 19, 2018·ESMO Open·Piercarlo SalettiMichele Ghielmini
Jun 14, 2020·Current Hematologic Malignancy Reports·Talal Hilal, Javier Munoz
Apr 12, 2019·Journal of Gastrointestinal Cancer·David L ChanSimron Singh

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