Evaluating the Impact of PET Scanning for Lymphoma Patients: Development of the Ontario PET Lymphoma Staging Registries

Transcription

1 Evaluating the Impact of PET Scanning for Lymphoma Patients: Development of the Ontario PET Lymphoma Staging Registries Applied Research in Cancer Control Conference 2015 Pamela MacCrostie, HBSc, CCPE Specialist, PET Scans Ontario Clinical Programs and Quality Initiatives, Cancer Care Ontario Co-authors: Colleen Bedford HBSc, Deanna L Langer PhD, Dr. Ur Metser, Dr. Matthew Cheung, Dr. David Hodgson

2 No conflicts of interest

3 Outline Motivation behind the Lymphoma Registry PET Scanning Overview PET Scanning in Ontario Lymphoma Registry Development Results The Future

4 Motivation Behind the Lymphoma Registry 2011 A review of the literature on PET in lymphoma found limited evidence that PET impacts patient management when used for staging limited-stage HL, NHL, nodal follicular and other indolent NHLs. A Registry was recommended to strengthen evidence for the Ontario context while providing streamlined patient access.

5 PET Scanning Overview Positron Emission Tomography Patient injected with radiopharmaceutical E.g., Radiolabeled sugar: 18F-fluorodeoxyglucose (FDG) Metabolic imaging: see increased metabolism, typically combined with anatomic image (from CT PET/CT ) Can see changes in chemistry before anatomically visible

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7 Lymphoma Registry - Development 2009 onwards October 2009 PET becomes a publicly insured health service in Ontario Includes 2 x Lymphoma indications Post treatment Response assessment (HL only) 2011 onwards 2011 Emerging evidence for the use of PET for staging lymphomas 2013 onwards May 2013 Lymphoma Staging Registry opens for accrual May 2015 >600 patients enrolled; Data analysis begins

8 Lymphoma Registry Development (cont d) Assess the evidence: Weak but compelling Registry Develop Forms Collaborate with Experts: Clarify Indications Data Elements Update etool with new indication Communication to relevant audiences Registry Opens

9 Lymphoma Registry Development (cont d) Lymphoma staging: PET for the staging of Hodgkin s or non-hodgkin s lymphoma being treated with curative intent: o for the staging of limited disease as per conventional imaging or o when imaging is equivocal for differentiating between limited and advanced stage disease. PET for apparent limited stage nodal follicular lymphoma or other indolent non-hodgkin s lymphomas where curative radiation therapy is being considered for treatment

10 Lymphoma Registry Development (cont d) Challenge #1 Measuring the impact of PET scanning on patient management Solutions Data collection includes treatment intent o Before PET scan AND o After PET scan

11 Lymphoma Registry Development (cont d) Intended treatment plan post PET scan

12 Lymphoma Registry Development (cont d) Challenge #2 Collecting the post scan treatment data Solutions Messaging to referring physicians o Build evidence = becomes Insured = no longer need to complete post scan data Automated s o o Upon completion of PET scan 2 weeks post PET scan Follow-up directly from PET Centres o leveraging relationships Lymphoma Newsletter (May 2014)

13 Number of scans Lymphoma Registry Results Lymphoma Registry Quarterly Scan Volumes Q1 Yr 1 Q2 Yr 1 Q3 Yr 1 Q4 Yr 1 Lymphoma Newsletter Distributed Q1 Yr 2 Lugano Classification System Announced Q2 Yr 2 Q3 Yr 2 Q4 Yr 2 Scan Volume Timeframe (Quarterly) (May 2013-April 2015)

14 Lymphoma Registry Results (cont d) >600 patients registered ~90% have aggressive histology disease (HL or NHL) ~10% have indolent forms of lymphoma Aggressive Lymphomas Indolent Lymphomas

15 Lymphoma Registry Results (cont d) MD Post Scan Forms Returned MD Post Scan Form Submission (before outreach) 35-50% MD Post Scan Form Submission (after outreach) 80% 80% 70% 60% 50% 40% 30% 20% 10% 0% Before Intervention After Newsletter (no Follow-up) After Newsletter (with Follow-up)

16 Lymphoma Registry The Future Data analysis to begin May years of data Registry will remain open during analysis to continue to provide streamlined access to PET scans Stay tuned in 2016 for the final analysis and recommendations regarding PET in staging lymphoma

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