PET’s impact on intended management shows consistency across indications

Results from PET scans can influence the management of cancer patients regardless of their cancer type or the reason for ordering the exam, according to the latest update from the National Oncologic PET Registry.

Preliminary results published by the NOPR in March in the Journal of Clinical Oncology indicated that FDG-PET led referring physicians to alter their intended clinical management for more than one-third of nearly 23,000 cancer patients who had been enrolled in the program up to that point.

Nearly two and a half years after the registry's creation, NOPR data from more than 40,000 PET studies performed at 1368 centers suggest that the impact of PET on physicians' intended patient management is similar across cancer types, according to lead investigator Dr. Bruce E. Hillner, associate chair of internal medicine at Virginia Commonwealth University.

The study included 18 different individual cancer types and looked at PET's impact on intended management for patients with known cancers of these types for staging (14,365 scans), restaging (14,584 scans), and suspected recurrence (14,584 scans). The investigative team was stunned to find no outlying individual cancer types for which PET's impact on intended management was exceptionally high or low, Hillner said. Hillner and colleagues published results in the December issue of the Journal of Nuclear Medicine (2008;49[12]:1928-1935, Epub 2008 Nov 7).

"Of course, there was some variation," Hillner said in an interview with Diagnostic Imaging. "But the dominant theme was the consistency of the utility."

NOPR scientists faced a setback in August at a public hearing held by the Centers for Medicare and Medicaid Services to review a request for expanded coverage. A CMS advisory panel came to the conclusion that clinical data for nine conditionally approved cancer indications of FDG-PET were too ambivalent to support the petition.

The investigative team sent a letter to CMS suggesting that, in view of the latest evidence, making a decision on a case-by-case basis would be counterproductive. Although the outcome is uncertain, researchers remain optimistic that CMS will look favorably at the latest findings before making a final coverage decision and hope that private insurers follow suit. In the meantime, eligible patients should continue to participate in the registry, Hillner said.

"It is impossible and unfair to make any projections about what CMS's position will be," he said. "But the NOPR was done in full cooperation with Medicare. That puts a unique flavor on the potential for how they may subsequently modify their policy. Only time will tell."

The CMS coverage decision is scheduled for January.

For more information from the Diagnostic Imaging archives:

PET registry study authors ask Medicare to expand coverage

PET alters management for one in three patients

NOPR paperwork bedevils payment for PET applications