Provider Follow-Up and Adherence to Imaging Surveillance Recommendations for Lung Cancer Survivors in a Nationwide Health Care System.

Abstract

With the growing number of cancer survivors and projected shortages of oncology providers, understanding who delivers survivorship care has important implications for care quality. We examined follow-up provider patterns among lung cancer survivors in the Veterans Health Administration (VHA) system and assessed variation in receipt of guideline-concordant computed tomography (CT) imaging. We conducted a retrospective cohort study of 20,532 Veterans with stage I to III non-small cell lung cancer who received definitive treatment between 2008 and 2016. The primary exposure was the lung cancer survivor's follow-up provider specialty, defined as the specialty with whom the patient received the most post-treatment follow-up visits. We evaluated associations between treatment type and follow-up provider specialty and compared receipt of guideline-concordant surveillance imaging, defined as chest CT performed 120-270 days after treatment, across specialties using multivariable logistic regression, adjusted for demographic, clinical, and facility characteristics. Follow-up care frequently shifted to specialties different from those delivering definitive treatment. Among patients treated with surgery alone, most patients, 61% transitioned to primary care for follow-up, while 27% remained with surgery. Patients followed by medical oncology had the highest rates of guideline-concordant chest CT (72.8% <i>v</i> 66.2% in primary care, adjusted odds ratio, 1.42 [95% CI, 1.31 to 1.53]; <i>P</i> < .001). Chest radiography was used in 26% of cases, most often in primary care and surgical clinics. Survivorship follow-up for lung cancer in the VHA often shifted to primary care, where adherence to guideline-concordant chest CT was lower than in medical oncology. These shifts in care may have further implications for post-treatment outcomes and survivorship care, highlighting the opportunity to support nononcology providers in delivering guideline-concordant care as survivorship workforce demands grow.