title: Intended versus inferred management after PET for cancer restaging: analysis of Medicare claims linked to a coverage with evidence development registry.
abstract: BACKGROUND
  The National Oncologic PET Registry (NOPR) ascertained changes in the intended management of cancer patients using questionnaire data obtained before and after positron emission tomography (PET) under Medicare's coverage with evidence development policy.
  
  
  OBJECTIVE
  To assess the concordance between intended care plans and care received as ascertained through administrative claims data.
  
  
  METHODS
  Analysis of linked data of NOPR participants from 2006 to 2008 and their corresponding Medicare claims.
  
  
  METHODS
  Consenting patients aged older than 65 years having their first PET for restaging of bladder, kidney, ovarian, pancreas, prostate, small cell lung, or stomach cancer.
  
  
  METHODS
  : Agreement (positive predictive values and κ) between NOPR post-PET intended management plans for treatment (systemic therapy, radiotherapy, surgery, or combinations), biopsy, or watching as compared to claims-inferred care 30 days after PET.
  
  
  RESULTS
  A total of 8460 patients with linked data were assessed. A total of 43.5% had metastatic disease and 45.3% had treatment planned (predominantly systemic therapy only), 11.1% biopsy and 43.5% watching. Claims-confirmed intended plans (positive predictive value) for single-mode systemic therapy in 62.0%, radiation in 66.0%, surgery in 45.6%, and biopsy in 55.7%. A total of 25.7% of patients with a plan of watching had treatment claims. By cancer type, κ ranged for systemic therapy only from 0.17 to 0.40 and for watching from 0.21 to 0.41. Agreement rates varied by cancer types but were minimally associated with patient age, performance status, comorbidity, or stage.
  
  
  CONCLUSIONS
  Among elderly cancer patients undergoing PET for restaging, there was moderate concordance between their physicians' planned management and claims-inferred actions within a narrow time window. When higher accuracy levels are required in future coverage with evidence development studies, alternative designs will be needed.
authors.affiliation: Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA. Hillner@vcu.edu
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hillner
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Qianfei
authors.initials: Q
authors.lastname: Wang
authors.forename: Yunjie
authors.initials: Y
authors.lastname: Song
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Lucy G
authors.initials: LG
authors.lastname: Hanna
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000191:economics; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging / Q000191:economics; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000473:pathology* / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D049268:Positron-Emission Tomography / Q000191:economics*; D012042:Registries; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States