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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2013

01-07-2013 | Pancreatic Tumors

Frequency and Intensity of Postoperative Surveillance After Curative Treatment of Pancreatic Cancer: A Cost-Effectiveness Analysis

Authors: Ching-Wei D. Tzeng, MD, Daniel E. Abbott, MD, Scott B. Cantor, PhD, Jason B. Fleming, MD, Jeffrey E. Lee, MD, Peter W. T. Pisters, MD, Gauri R. Varadhachary, MD, James L. Abbruzzese, MD, Robert A. Wolff, MD, Syed A. Ahmad, MD, Matthew H. G. Katz, MD

Published in: Annals of Surgical Oncology | Issue 7/2013

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Abstract

Background

Few data exist to guide oncologic surveillance following curative treatment of pancreatic cancer. We sought to identify a rational, cost-effective postoperative surveillance strategy.

Methods

We constructed a Markov model to compare the cost-effectiveness of 5 postoperative surveillance strategies. No scheduled surveillance served as the baseline strategy. Clinical evaluation and carbohydrate antigen (CA) 19-9 testing without/with routine computed tomography and chest X-ray at either 6- or 3-month intervals served as the 4 comparison strategies of increasing intensity. We populated the model with symptom, recurrence, treatment, and survival data from patients who had received intensive surveillance after multimodality treatment at our institution between 1998 and 2008. Costs were based on Medicare payments (2011 US dollars).

Results

The baseline strategy of no scheduled surveillance was associated with a postoperative overall survival (OS) of 24.6 months and a cost of $3837/patient. Clinical evaluation and CA 19-9 assay every 6 months until recurrence was associated with a 32.8-month OS and a cost of $7496/patient, with an incremental cost-effectiveness ratio (ICER) of $5364/life-year (LY). Additional routine imaging every 6 months incrementally increased total cost by $3465 without increasing OS. ICERs associated with clinic visits every 3 months without/with routine imaging were $127,680 and $294,696/LY, respectively. Sensitivity analyses changed the strategies’ absolute costs but not the relative ranks of their ICERs.

Conclusions

Increasing the frequency and intensity of postoperative surveillance of patients after curative therapy for pancreatic cancer beyond clinical evaluation and CA 19-9 testing every 6 months increases cost but confers no clinically significant survival benefit.
Appendix
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Literature
1.
Breslin TM, Hess KR, Harbison DB, Jean ME, Cleary KR, Dackiw AP, et al. Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol. 2001;8:123–32.PubMedCrossRef
2.
Thomas RM, Truty MJ, Nogueras-Gonzalez GM, Fleming JB, Vauthey JN, Pisters PW, et al. Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg. 2012;16:1696–704.PubMedCrossRef
3.
Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60.PubMedCrossRef
4.
Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.PubMedCrossRef
5.
Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine versus observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.PubMedCrossRef
6.
Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246:734–40.PubMedCrossRef
7.
Tjandra JJ, Chan MK. Follow-up after curative resection of colorectal cancer: a meta-analysis. Dis Colon Rectum. 2007;50:1783–99.PubMedCrossRef
8.
Rodriguez-Moranta F, Salo J, Arcusa A, Boadas J, Piñol V, Bessa X, et al. Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial. J Clin Oncol. 2006;24:386–93.PubMedCrossRef
9.
Rojas MP, Telaro E, Russo A, Moschetti I, Coe L, Fossati R, et al. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev. 2005;(1):CD001768.
10.
Salerni G, Lovatto L, Carrera C, Puig S, Malvehy J. Melanomas detected in a follow-up program compared with melanomas referred to a melanoma unit. Arch Dermatol. 2011;147:549–55.PubMedCrossRef
11.
Tzeng CW, Fleming JB, Lee JE, Wang X, Pisters PW, Vauthey JN, et al. Yield of clinical and radiographic surveillance in patients with resected pancreatic adenocarcinoma following multimodal therapy. HPB (Oxford). 2012;14:365–72.CrossRef
12.
Sheffield KM, Crowell KT, Lin YL, Djukom C, Goodwin JS, Riall TS. Surveillance of pancreatic cancer patients after surgical resection. Ann Surg Oncol. 2012;19:1670–7.PubMedCrossRef
13.
NCCN. Pancreatic adenocarcinoma Version 2.2012. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Fort Washington: National Comprehensive Cancer Network; 2012.
14.
Hwang RF, Wang H, Lara A, Gomez H, Chang T, Sieffert N, et al. Development of an integrated biospecimen bank and multidisciplinary clinical database for pancreatic cancer. Ann Surg Oncol. 2008;15:1356–66.PubMedCrossRef
15.
Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502.PubMedCrossRef
16.
Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–46; discussion 846–848.PubMedCrossRef
17.
Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3487–95.PubMedCrossRef
18.
Yen TW, Abdalla EK, Pisters PW, Evans DB. Pancreaticoduodenectomy. In: Von Hoff DD, Evans DB, Hruban RH, eds. Pancreatic Cancer. Sudbury: Jones and Bartlett; 2005: p. 265–86.
19.
Beck JR, Kassirer JP, Pauker SG. A convenient approximation of life expectancy (the “DEALE”). I. Validation of the method. Am J Med. 1982;73:883–8.PubMedCrossRef
20.
Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP. A convenient approximation of life expectancy (the “DEALE”). II. Use in medical decision-making. Am J Med. 1982;73:889–97.PubMedCrossRef
21.
Ljungman D, Lundholm K, Hyltander A. Cost-utility estimation of surgical treatment of pancreatic carcinoma aimed at cure. World J Surg. 2011;35:662–70.PubMedCrossRef
22.
Murphy JD, Chang DT, Abelson J, Daly ME, Yeung HN, Nelson LM, et al. Cost-effectiveness of modern radiotherapy techniques in locally advanced pancreatic cancer. Cancer. 2012;118:1119–29.PubMedCrossRef
23.
Cantor SB. Cost-effectiveness analysis, extended dominance, and ethics: a quantitative assessment. Med Decis Mak. 1994;14:259–65.CrossRef
24.
Braithwaite RS, Meltzer DO, King JT, Jr., Leslie D, Roberts MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care. 2008;46:349–56.PubMedCrossRef
25.
Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.PubMedCrossRef
26.
Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor’s perspective. J Clin Oncol. 2011;29:1280–9.PubMedCrossRef
27.
Katz MH, Hu CY, Fleming JB, Pisters PW, Lee JE, Chang GJ. Clinical calculator of conditional survival estimates for resected and unresected survivors of pancreatic cancer. Arch Surg. 2012;147:513–9.PubMedCrossRef
28.
Thompson CA, Charlson ME, Schenkein E, Wells MT, Furman RR, Elstrom R, et al. Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Ann Oncol. 2010;21:2262–6.PubMedCrossRef
29.
Petzel MQ, Parker NH, Valentine AD, Simard S, Nogueras-Gonzalez GM, Lee JE, et al. Fear of cancer recurrence after curative pancreatectomy: a cross-sectional study in survivors of pancreatic and periampullary tumors. Ann Surg Oncol. 2012;19:4078–84.PubMedCrossRef
30.
Asiyanbola B, Gleisner A, Herman JM, Choti MA, Wolfgang CL, Swartz M, et al. Determining pattern of recurrence following pancreaticoduodenectomy and adjuvant 5-flurouracil-based chemoradiation therapy: effect of number of metastatic lymph nodes and lymph node ratio. J Gastrointest Surg. 2009;13:752–9.PubMedCrossRef
31.
Meyers MO, Meszoely IM, Hoffman JP, Watson JC, Ross E, Eisenberg BL. Is reporting of recurrence data important in pancreatic cancer? Ann Surg Oncol. 2004;11:304–9.PubMedCrossRef
32.
Ballehaninna UK, Chamberlain RS. The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: an evidence based appraisal. J Gastrointest Oncol. 2012;3:105–19.PubMed
Metadata
Title
Frequency and Intensity of Postoperative Surveillance After Curative Treatment of Pancreatic Cancer: A Cost-Effectiveness Analysis
Authors
Ching-Wei D. Tzeng, MD
Daniel E. Abbott, MD
Scott B. Cantor, PhD
Jason B. Fleming, MD
Jeffrey E. Lee, MD
Peter W. T. Pisters, MD
Gauri R. Varadhachary, MD
James L. Abbruzzese, MD
Robert A. Wolff, MD
Syed A. Ahmad, MD
Matthew H. G. Katz, MD
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2889-6

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