NOPR: A Landmark Study
Initial Results from National Oncologic PET Registry (NOPR) have been published recently in the Journal of Clinical Oncology. The results provide impressive evidence for the substantial impact of PET imaging across all cancers. The concept of NOPR was developed by Bruce E. Hillner, Barry A. Siegel, Anthony F. Shields, and R. Edward Coleman, and was sponsored by the Academy of Molecular Imaging (AMI) with its industry and clinical councils and the American College of Radiology (ACR). The activities also were supported by the Society of Nuclear Medicine (SNM) and others. NOPR is still active and many cancer patients are still studied as part of this registry.
The question asked by NOPR investigators was whether FDG-PET imaging has any impact on managing patients with cancer who are currently not covered for PET imaging by CMS. It should be mentioned, that this first report describes the overall impact of FDG-PET imaging on managing cancer patients and that subsequent manuscripts will detail the impact of PET on managing specific cancers and also its impact on monitoring treatment responses.
The Journal of Clinical Oncology study reports findings in more than 20,000 patients. Impact data were stratified by cancer type and specific indication of the study such as diagnosing, staging and restaging.
FDG-PET had an impact on management in 30 to 40 percent of patients which is similar to previous investigations in cancers that were covered for reimbursement by CMS.
The NOPR report is a landmark study for several reasons: first, it is the first time that a large prospective national registry has been used to establish evidence for the impact of any imaging modality on cancer management. Second, it can serve as a model for many other applications of PET and other imaging modalities to prospectively assess their impact on patient management. Finally, NOPR was designed and is executed with the active participation of CMS, thereby establishing a novel collaborative assessment model of imaging technologies between regulatory agencies and healthcare providers.
With their work, the authors have established the evidence that FDG-PET imaging has an enormous impact on managing cancer patients. These data should now be used to request markedly broader CMS coverage for FDG-PET imaging.