TY - JOUR
T1 - Intended versus inferred treatment after 18 F-fluoride PET performed for evaluation of osseous metastatic disease in the national oncologic PET registry
AU - Hillner, Bruce E.
AU - Hanna, Lucy
AU - Makineni, Rajesh
AU - Duan, Fenghai
AU - Shields, Anthony F.
AU - Subramaniam, Rathan M.
AU - Gareen, Ilana
AU - Siegel, Barry A.
N1 - Funding Information:
The NOPR is sponsored by the World Molecular Imaging Society, managed by the American College of Radiology, and self-supported by the fees paid by participating PET facilities.
Publisher Copyright:
© 2018 by the Society of Nuclear Medicine and Molecular Imaging.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - We have previously reported that PET with 18 F-fluoride (NaF PET) for assessment of osseous metastatic disease led to changes in intended management in a substantial fraction of patients with prostate or other types of cancer participating in the National Oncologic PET Registry. This study was performed to assess the concordance of intended patient management after NaF PET and inferred management based on analysis of Medicare claims. Methods: We analyzed linked post-NaF PET data of consenting National Oncologic PET Registry participants age 65 y or older from 2011 to 2014 and their corresponding Medicare claims. Post-NaF PET treatment plans, including combinations of 2 modes of therapy, were assessed for their concordance with clinical actions inferred from Medicare claims. NaF PET studies were stratified by indication (initial staging [IS] or suspected first osseous metastasis [FOM]) and cancer type (prostate, lung, or other cancers). Agreement was assessed between post-NaF PET intended management plans for treatment (surgery, radiotherapy, or systemic therapy) within 90 d for lung and 18 0 d for prostate or other cancers, and for watching (the absence of treatment claims for $60 d) as compared with claims-inferred care. Results: Actions after 9,898 scans were assessed. After NaF PET for IS, there was claims agreement for planned surgery in 76.0% (19/25) lung, 75.4% (98/130) other cancers, and 58.9% (298/506) prostate cancer. Claims confirmed chemotherapy plans after NaF PET done for IS or FOM in 81.0% and 73.5% for lung cancer (n 5 148 and 136) and 69.4% and 67.5% for other cancers (n 5 111 and 228). For radiotherapy plans, agreement ranged from 80.0% to 84.4% after IS and 68.4% to 74.0% for suspected FOM. Concordance was greatest for androgen deprivation therapy (ADT) (86.0%, n 5 308) alone or combined with radiotherapy in prostate cancer IS (80.8%, n 5 517). In prostate FOM, the concordance across all treatment plans was lower if the patients had ADT claims within 18 0 d before NaF PET. Agreement with nontreatment plans was high for FOM (87.2% in other cancers and 78.6% if no prior ADT in prostate) and low after IS (40.7%-62.5%). Conclusion: Concordance of post-NaF PET plans and claims was substantial and higher overall for IS than for FOM.
AB - We have previously reported that PET with 18 F-fluoride (NaF PET) for assessment of osseous metastatic disease led to changes in intended management in a substantial fraction of patients with prostate or other types of cancer participating in the National Oncologic PET Registry. This study was performed to assess the concordance of intended patient management after NaF PET and inferred management based on analysis of Medicare claims. Methods: We analyzed linked post-NaF PET data of consenting National Oncologic PET Registry participants age 65 y or older from 2011 to 2014 and their corresponding Medicare claims. Post-NaF PET treatment plans, including combinations of 2 modes of therapy, were assessed for their concordance with clinical actions inferred from Medicare claims. NaF PET studies were stratified by indication (initial staging [IS] or suspected first osseous metastasis [FOM]) and cancer type (prostate, lung, or other cancers). Agreement was assessed between post-NaF PET intended management plans for treatment (surgery, radiotherapy, or systemic therapy) within 90 d for lung and 18 0 d for prostate or other cancers, and for watching (the absence of treatment claims for $60 d) as compared with claims-inferred care. Results: Actions after 9,898 scans were assessed. After NaF PET for IS, there was claims agreement for planned surgery in 76.0% (19/25) lung, 75.4% (98/130) other cancers, and 58.9% (298/506) prostate cancer. Claims confirmed chemotherapy plans after NaF PET done for IS or FOM in 81.0% and 73.5% for lung cancer (n 5 148 and 136) and 69.4% and 67.5% for other cancers (n 5 111 and 228). For radiotherapy plans, agreement ranged from 80.0% to 84.4% after IS and 68.4% to 74.0% for suspected FOM. Concordance was greatest for androgen deprivation therapy (ADT) (86.0%, n 5 308) alone or combined with radiotherapy in prostate cancer IS (80.8%, n 5 517). In prostate FOM, the concordance across all treatment plans was lower if the patients had ADT claims within 18 0 d before NaF PET. Agreement with nontreatment plans was high for FOM (87.2% in other cancers and 78.6% if no prior ADT in prostate) and low after IS (40.7%-62.5%). Conclusion: Concordance of post-NaF PET plans and claims was substantial and higher overall for IS than for FOM.
KW - Bone metastasis
KW - F-fluoride PET
KW - Insurance claims linkage
KW - Lung cancer
KW - Outcomes and process assessment
KW - Prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85044243482&partnerID=8YFLogxK
U2 - 10.2967/jnumed.117.205047
DO - 10.2967/jnumed.117.205047
M3 - Article
C2 - 29191854
AN - SCOPUS:85044243482
SN - 0161-5505
VL - 59
SP - 421
EP - 426
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 3
ER -