PET registry data confirm FDG-PET impact on cancer care management

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Clinicians changed the intended care of more than one in three cancer patients as the result of FDG-PET scan findings, according to a study of data from the National Oncologic PET Registry (NOPR), published online March 24 in the Journal of Clinical Oncology (JCO).

The study analyzed data regarding nearly 23,000 patients contributed to the NOPR by more than 1,200 facilities across the United States providing PET scans.

”The NOPR working group sought to measure the impact of PET findings on patient management in a manner minimally intrusive to care providers. This was critical for successfully collecting the large amount of data required for a robust analysis,” said Bruce Hillner, MD, lead author for the study and professor and university scholar in the department of internal medicine at Virginia Commonwealth University.

Sponsored by the Academy of Molecular Imaging (AMI) and managed by the American College of Radiology (ACR) and the ACR Imaging Network (ACRIN), the NOPR was designed to collect questionnaire data from referring physicians on intended patient management before and after a FDG-PET scan.

The NOPR participating PET facility collects from referring physicians both a pre-PET questionnaire (documenting study indication, cancer type and anticipated stage, and planned management if PET were not available) and one of several post-PET questionnaires that assess the referring physician’s planned management in light of the FDG-PET findings. 

Analysis of data collected found that FDG-PET is associated with a 36.5 percent change in the decision of whether or how to treat a patient’s cancer. 

NOPR working group Co-Chair R. Edward Coleman, MD, professor of radiology and chief of the division of nuclear medicine at Duke University School of Medicine and an AMI founding member, said they were especially surprised by the impact of the PET findings on patients who were originally planned to have a biopsy. The procedure was avoided in approximately three-quarters of these patients, he added.

The NOPR was launched in May 2006 in response to the Center for Medicare & Medicaid Services’ (CMS) “Coverage with Evidence Development” policy to collect data through a clinical registry to inform the center’s FDG-PET coverage determination decisions for currently non-covered cancer indications. 

Cancer types that Medicare currently covers for reimbursement only through the NOPR include those of the ovary, uterus, prostate, pancreas, stomach, kidney and bladder.

Oncologist and NOPR working group co-chair, Anthony Shields, MD, professor of medicine and oncology at the Karmanos Cancer Institute at Wayne State University and chair of ACRIN’s oncology committee, said the results confirm what they suspected from increasing experience with PET.  “However, we lacked the significant data required to prove the benefit of PET for many uncovered indications.  It’s very encouraging that oncologists and other clinicians may have access to the valuable information PET affords for ensuring the best patient care,” Shields said.

NOPR has formally asked CMS to reconsider the current National Coverage decision on FDG-PET to end the data collection requirements for diagnosis, staging and restaging. Medicare will review the published data and determine the next steps related to reimbursement for PET scans now only covered through the NOPR, Shields said.