Intended versus inferred treatment after 18F-fluoride PET performed for evaluation of osseous metastatic disease in the national oncologic PET registry

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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. 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 180 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 180 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.

Original languageEnglish (US)
Pages (from-to)421-426
Number of pages6
JournalJournal of Nuclear Medicine
Volume59
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Fluorides
Registries
Neoplasm Metastasis
Prostate
Medicare
Androgens
Neoplasms
Prostatic Neoplasms
Radiotherapy
Therapeutics
Lung Neoplasms
Insurance Claim Review
Lung
Neoplasm Staging
Drug Therapy

Keywords

  • F-fluoride PET
  • Bone metastasis
  • Insurance claims linkage
  • Lung cancer
  • Outcomes and process assessment
  • Prostate cancer

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Intended versus inferred treatment after 18F-fluoride PET performed for evaluation of osseous metastatic disease in the national oncologic PET registry. / Hillner, Bruce E.; Hanna, Lucy; Makineni, Rajesh; Duan, Fenghai; Shields, Anthony F.; Subramaniam, Rathan M.; Gareen, Ilana; Siegel, Barry A.

In: Journal of Nuclear Medicine, Vol. 59, No. 3, 01.03.2018, p. 421-426.

Research output: Contribution to journalArticle

Hillner, Bruce E. ; Hanna, Lucy ; Makineni, Rajesh ; Duan, Fenghai ; Shields, Anthony F. ; Subramaniam, Rathan M. ; Gareen, Ilana ; Siegel, Barry A. / Intended versus inferred treatment after 18F-fluoride PET performed for evaluation of osseous metastatic disease in the national oncologic PET registry. In: Journal of Nuclear Medicine. 2018 ; Vol. 59, No. 3. pp. 421-426.
@article{002eb454cc294d5f9af8fa0a5c996a79,
title = "Intended versus inferred treatment after 18F-fluoride PET performed for evaluation of osseous metastatic disease in the national oncologic PET registry",
abstract = "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. 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 180 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 180 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.",
keywords = "F-fluoride PET, Bone metastasis, Insurance claims linkage, Lung cancer, Outcomes and process assessment, Prostate cancer",
author = "Hillner, {Bruce E.} and Lucy Hanna and Rajesh Makineni and Fenghai Duan and Shields, {Anthony F.} and Subramaniam, {Rathan M.} and Ilana Gareen and Siegel, {Barry A.}",
year = "2018",
month = "3",
day = "1",
doi = "10.2967/jnumed.117.205047",
language = "English (US)",
volume = "59",
pages = "421--426",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "3",

}

TY - JOUR

T1 - Intended versus inferred treatment after 18F-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.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - 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. 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 180 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 180 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 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. 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 180 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 180 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 - F-fluoride PET

KW - Bone metastasis

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

UR - http://www.scopus.com/inward/citedby.url?scp=85044243482&partnerID=8YFLogxK

U2 - 10.2967/jnumed.117.205047

DO - 10.2967/jnumed.117.205047

M3 - Article

VL - 59

SP - 421

EP - 426

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 3

ER -