Are we choosing surveillance imaging in gastric and pancreatic cancers wisely? A population-based study

Background/Objective — Although gastric and pancreatic cancers are aggressive, there is no evidence that early detection of recurrence improves overall survival. We aimed to measure the frequency of surveillance imaging in patients after curative resection for gastric and pancreatic cancers.

Methods — We performed a population-based cohort study on patients in Ontario, Canada, with a first diagnosis of gastric and pancreatic cancer in 2003-2013. Health administrative databases were linked using unique encoded identifiers to record demographics, imaging frequency, and health resource utilization.

Results — The cohort comprised 2930 patients (2151 gastric, 779 pancreatic). The median age was 69 (38% female). The cumulative incidence of CT imaging overall was 74.3% after 1 year and 82.8% by 3 years. Imaging was more likely for pancreatic cancer compared to gastric cancer (p < 0.0001). On multivariate analysis, imaging was less likely for females and older patients and varied significantly by health district. Imaging frequency increased over the study period.

Conclusions — Significant and increasing numbers of patients received surveillance imaging after resection of gastric or pancreatic cancers despite lack of data to show its benefit. This data shows the need for the Choosing Wisely Canada recommendations (published after the study period) and serve as a baseline for future analyses.