Article Figures & Data
Figures
- FIGURE 1.
NOPR schema. See text for details.
- FIGURE 2.
Primary endpoint: change in intended management strategy.
Tables
Question Pre-PET Post-PET Clinical indication* × If known cancer, primary site† and working stage‡ 2 Questions specific to clinical indication 2–4 Patient performance status§ × Did PET scan enable you to avoid more tests or procedures? × Intended management¶ × × If ordering physician is treating physician × × Ordering physician consent for research use of data by NOPR × ↵* Clinical indication: Cancer diagnosis, initial staging, restaging, suspected recurrence, or treatment monitoring. Cancer diagnosis includes assessment of patients with cancer of unknown primary and suspected paraneoplastic syndromes as well as assessment of those with lesions suspected to be cancer.
↵† Cancer site: 30 different sites listed alphabetically with corresponding ICD-9 code (ICD is International Classification of Diseases). If not listed, cancer type and ICD-9 code may be entered under “other.”
↵‡ Working stage: No evidence of disease/in remission; localized disease only; regional by direct extension or lymph node involvement or both; metastatic (distant) with a single suspected site; metastatic (distant) with multiple suspected sites; unknown or uncertain.
↵§ Performance status (Eastern Cooperative Oncology Group [ECOG]): 0, asymptomatic; 1, symptomatic, fully ambulatory; 2, symptomatic in bed < 50% of the day; 3, symptomatic in bed > 50% of the day, but not bedridden; 4, bedridden.
↵¶ Intended management: See Figure 2.
- TABLE 2
95% Confidence Intervals for Different Probability Estimates of Minimally Important Difference in Change in Management
Lower bound of 1-sided 95% confidence intervals Sample size P = 5% P = 10% P = 20% P = 30% P = 50% n = 200 2.5 6.5 15.3 24.6 44.2 n = 500 3.4 7.8 17.1 26.6 46.3 n = 1,000 3.9 8.4 17.9 27.6 47.4 n = 5,000 4.5 9.3 19.1 28.9 48.8 P = “True” probability of change in intended patient management between Pre-PET and Post-PET forms.
Priority and relative frequency Diagnosis Staging Restaging and suspected recurrence Therapeutic monitoring 1 Pancreatic cancer Pancreatic cancer Ovarian cancer Lymphoma 2 Cancer of unknown primary site Small cell lung cancer Brain tumors Non–small cell lung cancer 3 Ovarian cancer Cervical cancer Metastatic colorectal cancer 4 Multiple myeloma Multiple myeloma Head and neck cancer 5 Esophageal cancer Approach 1 Approach 2 Approach 3 Nontreatment* Nontreatment* Nontreatment* Treatment† Treatment with curative intent‡ Treatment including same mode of therapy§ Treatment with palliative intent‡ Treatment with a change in mode of therapy§ ↵* Nontreatment strategies: combination of watch, imaging, biopsy, or supportive care.
↵† Treatment strategies: All forms of treatment strategies were equal without considering therapeutic goal or changes in mode of therapy.
↵‡ Curative or palliative intent: A change in therapeutic intent (e.g., curative to palliative) considered an important change without considering mode of therapy.
↵§ Change in mode of therapy: A major change (e.g., from surgery to chemotherapy) without consideration of curative or palliative intent. See Table 5.
- TABLE 5
Supplemental Data: Matrix of Combinations of Pre-PET and Post-PET Management Plans and Their Classification
Pre-PET plan Post-PET plan Watch More imaging Tissue biopsy Curative surgery Palliative surgery Curative chemotherapy Palliative chemotherapy Curative radiation Palliative radiation Supportive care Watch No change Minor Minor Major Major Major Major Major Major Minor More imaging Minor No change Minor Major Major Major Major Major Major Minor Tissue biopsy Minor Minor No change Major Major Major Major Major Major Minor Curative surgery Major Major Major No change Minor Major mode Major mode Major mode Major mode Major Palliative surgery Major Major Major Minor No change Major mode Major mode Major mode Major mode Major Curative chemotherapy Major Major Major Major mode Major mode No change Minor Major mode Major mode Major Palliative chemotherapy Major Major Major Major mode Major mode Minor No change Major mode Major mode Major Curative radiation Major Major Major Major mode Major mode Major mode Major mode No change Minor Major Palliative radiation Major Major Major Major mode Major mode Major mode Major mode Minor No change Major Supportive care Minor Minor Minor Major Major Major Major Major Major No change Minor = trivial change scored; Major = substantial increase or decrease in intensity of care between management plans; Major mode = substantial change in type of therapy even if treatment goal is unchanged.
2-category scoring: No change and Major (collapsing no change and Minor as well Major and Major mode); 3-category scoring: No change, Minor, and Major (collapsing Major and Major mode); 4-category scoring: No change, Minor, Major, and Major mode.
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