Bruce E. Hillner MD, Presenter: Nothing to Disclose

Barry A. Siegel MD, Abstract Co-Author: Medical Advisory Board, Radiology Corporation of America Speaker, Radiology Corporation of America Stockholder, Radiology Corporation of America Medical Advisory Board, Spectrum Dynamics Ltd Speaker, DMS Health Group Speaker, Siemens AG Speaker, Cardinal Health, Inc Consulting, Tyco Healthcare (Mallinckrodt Inc)

R. Edward Coleman MD, Abstract Co-Author: Research grant, General Electric Company Consultant, General Electric Company Speakers Bureau, Siemens AG Medical Advisory Board, Radiology Corporation of America Stockholder, Radiology Corporation of America Speakers Bureau, Radiology Corporation of America Speakers Bureau, Alliance Imaging, Inc

Anthony Shields MD, PhD, Abstract Co-Author: Consultant, Genentech, Inc Stockholder, Radiology Corporation of America Consultant, Radiology Corporation of America Consultant, Nascent Pharmaceuticals, Inc Research support, Nascent Pharmaceuticals, Inc Research support, Novartis AG Research support, AstraZeneca PLC Research support, Amgen Inc Research support, Pfizer Inc

Ilana F. Gareen PhD, Abstract Co-Author: Nothing to Disclose

Lucy Hanna MS, Abstract Co-Author: Nothing to Disclose

Sharon Hartson Stine, Abstract Co-Author: Nothing to Disclose

Dawei Liu PhD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The National Oncologic PET Registry (NOPR) was designed to meet the data collection requirements necessary for Medicare coverage of positron emission tomography (PET) for previously non-covered cancer types and indications. This report describes the impact of PET with F-18 fluorodeoxyglucose on physicians’ intended management based on data from the first seven months of NOPR operation to December 31, 2006.

The NOPR design and analysis plan are outlined in a companion paper. The cohort analyzed consisted of data for 16,292 PET studies, representing those cases where both the patient and the referring physicians consented to use of their data for research (86% of all cases). There was a nearly equal distribution of PET studies obtained for cancer diagnosis, initial staging, restaging, suspected cancer recurrence, and treatment monitoring (range 18% to 23%).

When intended management was classified as either treatment or non-treatment, physicians changed their management in 38.0% (95% CI, 37.2-38.6%) of cases after PET (range 31% to 46%, depending on indication). A change from non-treatment to treatment was much more common than the converse (29.6% vs. 8.4%). In 39% of patients whose pre-PET plan was treatment, the post-PET plan had a change in therapeutic intent (e.g., curative to palliative) or to a non-treatment. In patients switching from non-treatment to treatment after PET, the revised treatment goal was about equally divided between curative and palliative intent in cases of cancer diagnosis or initial staging. However, in cases of restaging, suspected recurrence or treatment monitoring, a palliative goal was 2 to 2.5 times more common. PET was associated much more frequently (23.8%) with modifications in non-treatment plans than with minor (7.9%) or major (2.9%) alterations in treatment mode.

This study of a large, representative national cohort confirms the findings of earlier studies that physicians often change their intended management based upon PET.

The impact of PET was seen across the full spectrum of its potential uses in cancer care in elderly patients.

Hillner, B, Siegel, B, Coleman, R, Shields, A, Gareen, I, Hanna, L, Hartson Stine, S, Liu, D, et al, , et al, , The Impact of Positron Emission Tomography on Expected Management of Patients with Cancer: Initial Results from the National Oncologic PET Registry (NOPR).  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5003600.html