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The Will Rogers Phenomenon Revisited

Karen G. Chee, MD; Danh V. Nguyen, PhD; Monica Brown, PhD; David R. Gandara, MD; Ted Wun, MD; Primo N. Lara Jr, MD

Arch Intern Med. 2008;168(14):1541-1549.

Background  The Will Rogers phenomenon occurs when newer technology allows for more sensitive detection of tumor spread, resulting in stage migration and an apparent improvement in patient survival. We investigated whether use of highly sensitive positron emission tomography (PET) scanning in non–small cell lung cancer has had this effect.

Methods  We performed a retrospective analysis involving 12 395 patients with non–small cell lung cancer in the pre-PET (1994-1998) and PET (1999-2004) periods. Interperiod differences in staging procedures, clinical variables, and patient survival were evaluated.

Results  There was a 5.4% decline in the number of patients with stage III disease and an 8.4% increase in the number of patients with stage IV disease in the PET period, corresponding with an increase in PET use from 6.3% to 20.1% (P < .001). The PET period predicted better survival with a hazard ratio (HR) of 0.95 (95% confidence interval [CI], 0.91-0.99) (P = .02). Use of PET was independently associated with better survival in patients with stage III (HR, 0.77; 95% CI, 0.69-0.85) and stage IV (HR, 0.64; 95% CI, 0.58-0.70) disease, but not those with stage I or II disease.

Conclusion  These data support the notion that stage migration is responsible at least in part for an apparent improvement in survival for patients with stage III and IV non–small cell lung cancer in the PET scan era.

Author Affiliations: UC Davis Cancer Center (Drs Chee, Gandara, Wun, and Lara) and UC Davis Clinical and Translational Science Center (Drs Nguyen and Wun), UC Davis Health System, Sacramento, California; Veterans Administration Northern California Health Care System (Drs Gandara, Wun, and Lara), Sacramento; and the Cancer Surveillance Program, California Cancer Registry, Sacramento (Dr Brown); and Division of Biostatistics, Department of Public Health Sciences, University of California, Davis (Dr Nguyen).

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