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.
