Optimizing Follow-up Care for Lung Cancer: Investigating PET/CT's Impact on Survival and Cost-effectiveness

Radboudumc and Amsterdam UMC partnered up to improve the follow-up care for lung cancer patients, by investigating the added value of PET/CT scans in the follow-up of stage III non-small cell lung cancer. Since January 2024 recruitment has begun for the NVALT31-PET study, funded by Zorginstituut Nederland and endorsed by NVALT. With 25 hospitals already onboard and more joining the initiative, we aim to enhance early detection of recurrences or metastases.

In the Netherlands, follow-up care for lung cancer patients consists of CT scans of the lungs. However, a CT scan only detects recurrence or metastases in the chest area, while there is also a significant risk of distant metastases elsewhere in the body. In addition, after radiotherapy, the interpretation of changes on a CT scan is notably difficult. As a result, new metastases or local recurrence are often detected at a late stage, limiting treatment options. In recent years, treatment options for patients with only a few metastases have significantly increased. Examples include: highly targeted radiation therapy, immunotherapy, or surgery, which improve the chances of longer survival with a good health-related quality of life. However, these treatments may only prolong overall survival if the metastases or recurrence are detected in time. The NVALT31 -PET study aims to investigate whether PET/CT scans can improve early detection. Specifically, this study compares the added value of 18F FDG PET/CT scans during three year follow-up on survival and cost-effectiveness with the current follow-up method of using only a CT scan.

The study consists of two groups:

The control group. Patients in this group receive CT scans according to current guidelines, as is standard care.
The intervention group. In addition to the usual CT scans, patients in this group receive 5 PET/CT scans over a course of three-year follow-up.

Participants are randomly assigned to one of these groups. Patients in both groups are asked to complete questionnaires to measure health-related quality of life, distress, fear of cancer recurrence and medical consumption and productivity costs. These questionnaires are sent before each scan appointment.

Optional additional components for the intervention group include:

An interview evaluating the potential inclusion of PET/CT as a standard follow-up scan, and its effect on distress.
Blood tests to explore whether ctDNA is a better predictor of metastases than a PET/CT scan.

We expect that early detection of tumor recurrence may prolong survival and health-related quality of life and thereby lower the disease burden. In the future, this research may offer significant insights into optimizing follow-up care for lung cancer patients. Concurrently, immediately after the study, Zorginstituut Nederland will decide whether PET/CT scans during follow-up will be reimbursed.