We have previously reported that positron emission tomography using 18F-fluoride (NaF-PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF-PET results and hospice claims within 180 days and 1-year survival. Methods: We classified NOPR NaF-PET results linked to Medicare claims by imaging indication [initial staging (IS); detection of suspected first osseous metastasis (FOM); suspected progression of osseous metastasis (POM); or treatment monitoring (TM)] and type of cancer (prostate, lung, breast or other). Results were classified as definitely positive versus probably positive versus negative scan findings for osseous metastasis for IS and FOM; more extensive versus no change/less extensive disease for POM; and worse versus no change/better prognosis for TM, based on the post-scan assessment. Our study included 21,167 scans performed from 2011-2014 of consenting NOPR participants 65 years and older. Results: Relative risk of hospice claims within 180 days of NaF-PET scan ranged from 2.0 to 7.5 times higher for patients with evidence of new or progressing osseous metastasis, compared with those without, depending on indication and cancer type (all p<0.008). The percent difference in hospice claims for those with a finding of new or more advanced osseous disease ranged from 3.9% for IS prostate patients to 28% for FOM lung. Six-month survival was also associated with evidence of new or increased osseous disease; risk of death was 1.8 to 5.1 times as likely (all p<0.0001), with percent differences of approximately 30% comparing positive and negative scans in patients with lung cancer imaged for IS or FOM. Conclusion: Our analyses demonstrate that NaF-PET scan results are highly associated with subsequent hospice claims and, ultimately, with patient survival. NaF-PET provides important information on the presence of osseous metastasis and prognosis, to assist patients and their physicians when making decisions on whether to select palliative care and transition to hospice, or continue treatment.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2017 Dec 28 [Epub ahead of print]
Ilana F Gareen, Bruce E Hillner, Lucy Hanna, Rajesh Makineni, Fenghai Duan, Anthony F Shields, Rathan M Subramaniam, Barry Siegel
Brown University, United States., Virginia Commonwealth University, United States., Karmanos Cancer Institute, United States., UT Southwestern Medical Center, United States., Washington University School of Medicine, United States.