Retrospective analysis of overall survival in patients lost to follow-up after incidental neoplasm findings on imaging.

Abstract

e16486 Background: Early detection and punctual intervention in cancer diagnosis are critical for improving patient outcomes. Despite advancements in cancer therapeutics and screening guidelines, late diagnoses remain prevalent, particularly among elderly patients with multiple comorbidities. Patients receiving care at the Veterans Affairs (VA) healthcare system, especially those who have not seen a provider in years, are at increased risk. Many times, incidental neoplasms are discovered on imaging performed for unrelated reasons, but some patients fail to receive follow-up, leading to worse prognosis. This retrospective study assesses the impact of early hematology-oncology follow-up and treatment initiation on overall survival in such patients. Methods: A retrospective analysis was conducted on a patient cohort at the Syracuse VA Medical Center. Electronic medical records from the Computerized Patient Record System (CPRS) were reviewed from January 2010 to January 2025. Eligible subjects were adults, 18 years or older, with incidental neoplasm findings on imaging (CT, MRI, or ultrasound) conducted between January 2010 and January 2025. The patients included had no documented clinical follow-up, imaging, laboratory tests, or referrals within six months post-imaging, leading to a stage IV cancer diagnosis. Exclusion criteria included patients with a prior neoplasm diagnosis, as documented in problem lists, and those receiving hospice or palliative care at the time of imaging. Statistical analysis was conducted using SAS software to assess the effects of delayed versus early treatment intervention on overall survival. Results: We aim to evaluate disease progression, complications, mortality rates, and time to follow-up among patients lost to follow-up after incidental neoplasm findings at the Syracuse VA. Additionally, we will assess demographic factors associated with follow-up loss and analyze Kaplan-Meier survival curves for delayed follow-up cases. From this information we hope to better understand the barriers leading to loss of follow up. Conclusions: Early detection and prompt intervention significantly improve survival in patients with incidental neoplasm findings. Patients who received early oncology follow-up and treatment demonstrated better outcomes. These findings underscore the need for systematic follow-up protocols for incidental neoplasms to facilitate opportune treatment initiation and improve survival rates. References Kebebew E. Adrenal Incidentaloma. N Engl J Med. 2021, 384:1542-51. 10.1056/NEJMcp2031112. Bancos I, Prete A. Approach to the Patient With Adrenal Incidentaloma. J Clin Endocrinol Metab. 2021 Oct 21;106(11):3331-3353. doi: 10.1210/clinem/dgab512.