Intended Versus Inferred Care After PET Performed for Initial Staging in the National Oncologic PET Registry

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FIGURE 1.
Frequency of chemotherapy claims and E&M claims by cancer type among subjects for whom NOPR intended-management plan was chemotherapy. We excluded ovarian cancer because gynecologic oncologists in addition to medical oncologists often give systemic therapies.

TABLE 1

NOPR Cohort Clinical Characteristics for PET Imaging Performed for Initial Staging

	Cancer type
Characteristic	Combined	Bladder	Ovarian	Pancreatic	SCL	Stomach
Patients in cohort (n)	4,661	1,178	309	1,250	752	1,172
Age (y)
Mean	74.8	76.4	73.0	73.7	73.6	75.7
Interquartile range	72–77	71–81	68–77	68–78	69–77	70–81
Eastern Cooperative Oncology Group performance status (%)
0, asymptomatic	26.6	32.8	28.2	23.4	19.7	27.7
1, symptomatic, fully ambulatory	58.9	53.2	60.2	62.8	62.5	57.8
2 or higher	14.5	14.0	11.7	13.8	17.8	14.4
Post-PET summary stage (%)
No residual disease	6.8	9.0	14.9	4.5	0.9	8.8
Local only	30.3	36.9	20.7	30.5	14.4	36.2
Regional (or nodal) diseases	19.8	16.3	17.2	19.4	27.0	19.7
Metastatic disease, single site	11.5	8.2	8.7	15.5	13.4	10.0
Metastatic disease, multiple sites	28.0	26.5	33.3	26.7	42.2	20.2
Not recorded	3.6	3.1	5.2	3.4	2.1	5.1
Comorbidity index score (%)
0	36.3	36.3	55.3	37.8	25.0	37.0
1 or 2	46.9	42.3	36.6	49.3	56.1	45.8
≥3	16.8	21.4	8.1	13.0	18.9	17.2
Referring physician specialty (%)
Medical oncology	55.1	55.9	57.0	54.9	54.9	54.2
Internal medicine^*	11.2	5.2	5.8	9.8	19.8	14.4
Radiation oncology	9.0	12.5	1.3	11.5	11.0	3.5
Surgery	7.2	0.9	2.9	10.3	2.5	14.3
Urology	3.5	13.7	0.3	0.1	0.0	0.1
Gynecology/gynecologic oncology	1.5	0.3	19.7	0.2	0.0	0.2
Other	12.5	11.5	12.9	13.1	11.7	13.3
60-d post-PET mortality (%)	10.0	6.8	4.8	12.6	12.8	10.0
Pre-PET plan (%)
Watching	1.9	2.4	3.2	1.7	1.0	2.0
Additional imaging	36.2	36.2	40.8	32.1	41.6	36.0
Biopsy	8.0	9.5	6.8	9.6	4.8	7.2
Treatment	53.9	52.0	49.2	56.6	52.7	54.9

↵* Internal medicine: sum of all subspecialties other than hematology and oncology.

TABLE 2

NOPR-Intended Management Plan After PET for Initial Staging by Cancer Type

TABLE 3

Agreement Measurements by Type of Intended Therapy at 60 Days After PET

		PPV		Raw agreement		Kappa
Post-PET planned therapy and cancer type	NOPR plan (n)	%	95% confidence interval	%	95% confidence interval	κ	95% confidence interval
Any systemic therapy
All	3,030	79.3	77.9–80.8	74.1	72.7–75.4	0.40	0.37–0.43
Bladder	676	79.0	75.9–82.1	73.0	75.6–79.0	0.42	0.36–0.48
Ovarian	223	86.1	81.6–90.6	82.5	78.1–86.9	0.52	0.41–0.64
Pancreatic	854	79.3	76.6–82.0	72.8	70.3–75.4	0.33	0.27–0.39
SCL	629	89.5	87.1–91.9	83.8	81.2–86.5	0.34	0.24–0.43
Stomach	648	67.6	64.0–71.2	67.6	64.8–70.4	0.34	0.29–0.40
Any radiation
All	1,293	64.7	62.1–67.3	80.8	79.6–82.0	0.53	0.51–0.56
Bladder	337	68.8	63.9–73.8	83.3	81.1–85.5	0.60	0.55–0.65
Ovarian	23	30.4	11.6–49.2	91.6	88.4–94.8	0.32	0.12–0.53
Pancreatic	362	70.2	65.5–74.9	82.8	80.6–84.9	0.59	0.54–0.64
SCL	321	69.2	64.1–74.2	72.5	69.3–75.8	0.44	0.38–0.51
Stomach	250	48.8	42.6–55.0	79.0	76.5–81.4	0.39	0.32–0.45
Any surgery
All	1,031	63.6	60.7–66.6	77.9	76.7–79.2	0.43	0.40–0.46
Bladder	248	56.9	50.7–63.0	75.8	73.2–78.3	0.36	0.30–0.42
Ovarian	57	52.6	39.7–65.6	75.9	69.6–79.3	0.31	0.19–0.44
Pancreatic	242	59.9	53.7–66.1	77.8	74.1–78.8	0.39	0.33–0.45
SCL	26	50.0	30.8–69.2	85.4	82.6–87.7	0.15	0.06–0.24
Stomach	458	71.4	67.3–75.5	75.7	70.3–75.4	0.50	0.45–0.56

TABLE 4

Impact of Time Interval After PET on Claims Confirmation (PPV) of Post-PET Plan

Cancer type and treatment categories in Post-PET Plan	Patients (n)	Claims confirmed at 60 d (%)	Claims confirmed at 180 d (%)
Bladder
Chemotherapy/immunotherapy only	387	81.1	84.2
Chemotherapy and radiotherapy	182	62.1	69.2
Surgery only	129	73.6	90.7
Surgery and (chemotherapy or radiotherapy)	117	23.5	60.5
Pancreatic
Chemotherapy only	530	85.3	88.7
Chemotherapy and radiotherapy	225	53.8	69.8
Surgery only	135	74.1	80.0
Surgery and (chemotherapy or radiotherapy)	107	36.4	51.4
Stomach
Chemotherapy only	332	69.6	78.2
Chemotherapy and radiotherapy	126	47.6	61.9
Surgery only	264	80.3	86.4
Surgery and (chemotherapy or radiotherapy)	194	31.4	60.8
Ovarian
Chemotherapy only	169	90.5	93.5
SCL
Chemotherapy only	349	88.8	89.7
Chemotherapy and radiotherapy	270	62.6	73.0

TABLE 5

Factors Associated with Agreement of Treatment Plan and Claims for Treatment

↵* Logistic regression was used to assess factors affecting proportion of individual plans agreeing with subsequent claims. Factor categories assessed were age (<75, >75 y), performance status (0, 1, ≥2), comorbidity (0, 1 or 2, 3+), cancer type (bladder, ovarian, pancreatic, SCL, stomach), provider specialty (medical oncology, gynecology, internal medicine, radiation oncology, surgery, and other), and pre-PET plan (image, biopsy, treatment, watch). On basis of logistic regression model, adjusted percentage agreements were calculated for each category and range calculated.
Complete details of individual factor agreements are available in Supplemental Table 2.