PET Steering Committee Meeting Minutes. Tuesday, November 15, Time: 3:00 5:00 pm

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1 PET Steering Committee Meeting Minutes Tuesday, November 15, 2011 Time: 3:00 5:00 pm Committee Members: W.K. Evans (Chair), U. Metser, J. You, M. Freeman, Rob Beanlands, S. Houle, M. Greenberg Other Attendees: S. Henderson, S. Kherani, Saul Melamed, Leanne Palilionis, A. Singnurkar, M. Wang, G. Wisenberg Business 1. Opening Remarks 1.1 The Chair asked everyone to look at the minutes carefully to ensure the discussion on the Head and Neck cancer were captured accurately 1.2 The minutes from October 14, 2011 were approved as circulated 1.3 Updates from the Chair Esophageal Cancer correspondence has been sent to the Ministry with supporting information to recommend moving esophageal cancer indication from registry to an insured service. The Ministry has suggested revised wording for the Schedule of Benefit which is as follows: Baseline staging assessment of those patients diagnosed with esophageal cancer being considered for curative therapy. Repeat PET/CT scan on completion of pre-operative/neoadjuvant therapy, prior to surgery. The Ministry has approved the inclusion of this recommendation for the next iteration of the Schedule of Benefits. The committee accepted the wording as communicated and this will be relayed back to the Ministry by L. Palilionis Action: L. Palilionis to report to the committee when the Esophageal Carcinoma is added to the Schedule of Benefits as an insured indication PET CAM The results of the PET CAM trial does not recommend PET/CT for liver metastases from colorectal cancer with some exceptions. Action: Drs. Metser and Gallinger to provide recommendations at the next meeting for these exceptional cases Page 1 of 5

2 1.4 Review of follow-up Items from Previous Meetings List of Specialists to Direct Pet Awareness Campaign A list of specialists to target for the PET awareness campaign was circulated via to all members It was agreed by the committee that Primary Care Physicians and Dermatologists would not be included in this communication. It was also agreed by the committee to include the small number of Orthopaedic Oncologists. PET Awareness Document Communication has developed a summary of the PET program to be distributed to the imaging community to increase awareness of PET. It describes all the component parts of the PET/CT Program. This communication will be sent to the list of specialists that has been agreed upon. Action: The edited version of the PET awareness document to be distributed to all members with the minutes of today s meeting Recommendation related to Head and Neck Cancer Care The minutes from the October meeting captured the discussion on Head and Neck as follows: PET is recommended for the staging of nasopharyngeal cancer as there is a high incidence of distant metastatic disease in this type of Head and Neck cancer. PET is recommended in patients with metastatic squamous cell carcinoma presenting in neck nodes when the results of standard radiologic investigation do not reveal the primary site. PET may be useful in the staging of patients with recurrent squamous cell carcinoma of the Head and Neck when major salvage treatment is being considered. As there is not a strong evidentiary base for this recommendation, it was felt that there would be value in establishing this as a registry indication There was agreement on the first two recommendations and the following was suggested to be added to the third recommendation above: after salvage treatment..surgery or radical radiotherapy is being considered. It was recommended that this recommendation be considered as a registry service. Action: The above will be vetted with the Head and Neck community. Delays in Accessing PET scans for Patients with Lung Cancer PET centres want a confirmation of a definitive lung cancer diagnosis before they book a lung scan for patients to ensure reimbursement for the scan. This is building in a delay into the care of these patients Page 2 of 5

3 Action: A communication will be distributed to the PET Centres and thoracic surgeons to provide a guideline in dealing with these cases Lymphoma Guideline An update on the status of the Lynphoma guideline was provided. The guideline will provide a recommendation on the role of PET/CT in the clinical management of patients with lymphoma with respect to diagnosis, staging, treatment response and recurrence. Action: S. Henderson will provide the finalized project plan for review at the December meeting 2.2 Uninsured Program Key Statistics from Access Program for Posting on PET Website Key metrics were presented for posting on the PET website to stay in line with CCO principles of transparency and sharing of performance related information. The following information was proposed for posting: 1. Turn-around-time (TAT) from receiving a request from a clinician for a PET scan to approval of the request by CCO (this involves engaging the expert panel). The benchmark is 5 business days. 78% of the requests are completed within 2 business days 2. The number and approval rate of requests between May 2010 and June Number and major specialist types that request PET scans 4. TAT from approval of PET scan by expert panel to performance of the scan at the PET Centres The committee felt the reason for non-approval should also be posted on the website. The Chair asked if this data is easy to extract, then it should be posted. Action: S. Kherani to investigate if the non-approval reasons are easily extracted from the database. If not, the top reasons for non-approval should be posted. Request for Standardized PET Requisition for Insured Cardiac PET PET Centres have been inquiring about having access to a requisition for insured cardiac PET scan. R. Beanlands advised that there is a requisition that has been developed and reviewed and will be made available. In the meantime the referring physician can use another requisition until this is available. Action: R. Beanlands to make the insured Cardiac PET requisition available for posting on the CCO and CCN website 3.0 Cardiac PET Statement from Cardiac PET Sub-Committee: Statement #1 Based on existing evidence from prior systematic review and recent literature on safety and efficacy, the current practice of consideration of all nuclear tomographic imaging regardless of tracer or technology as equivalent and interchangeable remains reasonable. Page 3 of 5

4 Statement #2 Supplementary reimbursement above and beyond what exists currently for PET perfusion imaging and flow quantification should await updated literature review for the clinical utility and this review should consider the advantages and complexities of performing PET perfusion and flow quantification. Statement #1 - Details The Cardiac subcommittee announced that Rubidium has been approved by Health Canada. Rubidium is an agent used to measure perfusion imaging. Rubidium has a couple of specific advantages: PET images show increased accuracy and Rubidium has the ability to quantify blood flow which is not available with SPECT imaging. It also produces images with five times less radiation exposure to the patient then Sestamibi and ten times less radiation exposure then Thallium. The committee reviewed the information and the data in the literature and would like to recommend incorporation of perfusion imaging using Rubidium for all PET imaging There already exists a billing code for perfusion imaging in the Schedule of Benefits Statement #2 - Details Literature suggests that there is added value in using Rubidium (PET) over SPECT Imaging. It was recommended that Rubidium PET undergo a full evidentiary review and then be presented at the Cardiac PET subcommittee and PET Steering committee for final approval for use as a perfusion agent for PET Action: The evidentiary review for Rubidium for PET would be performed in the Fall of 2011 and presented to the Cardiac sub-committee in January 2012 and the PET Steering sub-committee shortly thereafter. Cardiac Sarcoidosis Registry Cardiac Sarcoidosis PET scans are continuing to be provided via the PET Access program. Data is being acquired and it is anticipated that funding support for the registry will be available. Action: Cardiac sub committee to provide volumes for PET scans for Cardiac Sarcoidosis at the meeting in December 4. Head and Neck Cancer Recommendation (see page2) 5. OCOG ACRIN had expressed an interest in collaborating with us on a couple of trials, but the trials proposed by ACRIN had already been done in Ontario. Currently, we have one ongoing trial, which is PET Lace (Impact of PET in Women with Locally Advanced Cervical Cancer). Dr. Peter Chung had spoken about doing a trial on testicular cancer at a previous PET Steering Committee meeting. Testicular cancer is not a very common cancer and the indication related to PET would make it even harder to recruit subjects. The Chair proposed asking ACRIN if they may be Page 4 of 5

5 interested in participating in a trial for testicular cancer. Collaboration with ACRIN would provide access to a large US population and funding Action: Chair to speak to Dr. Levine about a proposal to collaborate with ACRIN on a testicular cancer trial 6.Other Business Pediatric PET Sub-Committee A meeting has been scheduled in December to kick start this committee. Action: Feedback will be provided at the January 2012 PET Steering Committee meeting Recruitment PET Steering Committee Chair and Members Information has been submitted to the imaging community and CCO is awaiting responses from individuals interested in the Chair or member role as per the Terms of Reference The Meeting was adjourned at 4:12pm Page 5 of 5