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

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% v 66.2% in primary care, adjusted odds ratio, 1.42 [95% CI, 1.31 to 1.53]; P < .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.