Intended vs. Inferred Treatment after 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

We have previously reported that PET with 18F-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 (NOPR). 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-PET data of consenting NOPR participants age > 65 years from 2011 to 2014 and their corresponding Medicare claims. Post-PET treatment plans, including combinations of two 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-PET intended management plans for treatment (surgery, radiotherapy, or systemic therapy) within 90 days for lung and 180 days for prostate or other cancers, and for watching (the absence of treatment claims for 60 days) as compared to 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 = 148 and 136) and 69.4% and 67.5% for other cancers (n = 111 and 228). For radiotherapy plans, agreement ranged from 80.0%-84.4% after IS and 68.4%-74.0% for suspected FOM. Concordance was greatest for androgen deprivation therapy (ADT) alone or combined with radiotherapy in prostate cancer IS (86.0 %, n = 308; 80.8%, n = 517). In prostate FOM, the concordance across all treatment plans was lower if the patients had ADT claims within 180 days before NaF-PET. Agreement with non-treatment plans was for FOM (87.2% in other cancers and 78.6% if no prior ADT in prostate) and low after IS (40.7% to 62.5%). Conclusion: Concordance of post NaF-PET plans and claims was substantial and higher overall for IS than for FOM.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2017 Nov 30 [Epub ahead of print]

Bruce E Hillner, Lucy Hanna, Rajesh Makineni, Fenghai Duan, Anthony F Shields, Rathan M Subramaniam, Ilana Gareen, Barry A Siegel

Virginia Commonwealth Univ., United States., Brown University Center for Statistical Sciences, United States., Brown, United States., Karmanos Cancer Institute, United States., UT Southwestern Medical Center, United States., Brown University School of Public Health, United States., Mallinckrodt Institute of Radiology, United States.