NOPR Update on Effectivity
of PET/CT
Philadelphia — Clinicians changed the intended care of
more than one in three cancer patients as the result of FDG—PET and FDG—PET/CT
scan findings, according to a study of data from the National Oncologic PET Registry,
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 1200 facilities nationwide providing positron emission tomography
(PET) and PET/CT hybrid scans.
”The NOPR working group sought to measure the impact of PET and PET/CT
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, M.D., lead author for the study
and professor and eminent 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 or
FDG—PET/CT 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 and FDG—PET/CT
findings.
Analysis of data collected found that FDG—PET and FDG—PET/CT is associated
with a 36.5% 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, comments,
“We were especially
surprised by the impact of the PET/CT findings on patients who were originally
planned to have a biopsy. The procedure was avoided in approximately three quarters
of these patients.”
The NOPR was launched in May 2006 in response to the Center for Medicare and
Medicaid Services’ (CMS) novel “Coverage with Evidence Development” policy
to collect data through a clinical registry to inform the center’s FDG—PET
and FDG—PET/CT coverage determination decisions for currently non—covered
cancer indications.
Cancer types Medicare currently covers for reimbursement only through the NOPR
include those of the ovary, uterus, prostate, pancreas, stomach, kidney and bladder.
(For a complete list of NOPR covered cancer types and indications, go to
www.cancerpetregistry.org.)
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 says of the research results, “These
results confirm what we 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.”
NOPR has formally asked CMS to reconsider the current National Coverage decision
on FDG—PET and FDG—PET/CT and 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 and PET/CT scans
now only covered through the NOPR. Barry Siegel, MD, FACR, professor of radiology
and chief of the Division of Nuclear Medicine at the Mallinckrodt Institute of
Radiology at Washington University and chair of ACRIN’s PET Imaging Core
Laboratory, also serves as an NOPR working group co—chair.
"Based
on these data, Medicare should strongly consider opening up the coverage to include
diagnosis, staging and restaging for all cancers, states Dr Siegel.”
Washington Imaging Services was a member of the original group of National Oncologic
PET Registry participants and has been an active data provider throughout the
clinical trials. The NOPR remains active and will do so for the immediate future.
Please call 425-688-0100, Ext 8133 to schedule your patient.. For additional
information on PET/CT, please call or e-mail Gary Beneze, PET/CT Program Director
at 425-462-4742 or
gbeneze@washingtonimaging.com.
