Perceived value drives use of routine asymptomatic surveillance PET/CT by physicians who treat head and neck cancer

Head Neck. 2020 May;42(5):974-987. doi: 10.1002/hed.26071. Epub 2020 Jan 10.


Background: Why physicians use surveillance imaging for asymptomatic cancer survivors despite recommendations against this is not known.

Methods: Physicians surveilling head and neck cancer survivors were surveyed to determine relationships among attitudes, beliefs, guideline familiarity, and self-reported surveillance positron-emission-tomography/computed-tomography use.

Results: Among 459 responses, 79% reported using PET/CT on some asymptomatic patients; 39% reported using PET/CT on more than half of patients. Among attitudes/beliefs, perceived value of surveillance imaging (O.R. 3.57, C.I. 2.42-5.27, P = <.0001) was the strongest predictor of high imaging, including beliefs about outcome (improved survival) and psychological benefits (reassurance, better communication). Twenty-four percent of physicians were unfamiliar with guideline recommendations against routine surveillance imaging. Among physicians with high perceived-value scores, those less familiar with guidelines imaged more (O.R. 3.55, C.I. 1.08-11.67, P = .037).

Conclusions: Interventions to decrease routine surveillance PET/CT use for asymptomatic patients must overcome physicians' misperceptions of its value. Education about guidelines may modify the effect of perceived value.

Keywords: PET/CT; head and neck cancer; physician decision-making; surveillance imaging; value.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Squamous Cell*
  • Fluorodeoxyglucose F18
  • Head and Neck Neoplasms* / diagnostic imaging
  • Head and Neck Neoplasms* / therapy
  • Humans
  • Physicians*
  • Positron Emission Tomography Computed Tomography
  • Positron-Emission Tomography
  • Tomography, X-Ray Computed


  • Fluorodeoxyglucose F18