The Use of Positron Emission Tomography (PET) for Cancer Care

The Use of Positron Emission Tomography (PET)
(PET) for Cancer Care Across Canada: for Cancer Care Across Canada:
Time for a National Strategy
Report
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Release Briefing
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February 27, 2012
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The Use of Positron Emission Tomography (PET)
(PET) for Cancer Care Across Canada: for Cancer Care Across Canada:
Time for a National Strategy
Susan D. Martinuk
Report Release Briefing
February 27, 2012
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CANCER in CANADA
CANCER in CANADA
Aff t 82% f C
Affects 82% of Canadians
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One of every four will die from cancer
40% of women and
40% of women and
45% of men will develop cancer
Every HOUR, 8 Canadians die from cancer
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Every HOUR, 20 are diagnosed with cancer
HOUR 20
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2011 Canadian Cancer Statistics
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Ssss
Saku Koivu returns to hockey following cancer treatments
PET imaging played a crucial role in his speedy recovery
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Saku Koivu cuts ribbon on PET scanner for
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Montreal
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PET (Positron Emission Tomography) (Positron Emission Tomography)
nuclear medicine imaging technology used for diagnosis, not treatment
visualizes the body at the cellular level
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detects changes in the biological function of cells before they undergo anatomical changes to create a mass or tumour
• detects cancer cells at an early stage
• early detection prompts more timely treatment and improves probability early detection prompts more timely treatment and improves probability
of successful outcome
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Roles of PET in Oncology
» Initial Diagnosis
» Staging/Detecting Recurrence
» Monitoring Response to Therapy
» Patient Management
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CLINICAL EFFECTIVENESSS OF PET
CLINICAL EFFECTIVENESSS OF PET
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Three Large Studies in the United States (NOPR)
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St di i th U it d St t (NOPR)
PET changed patient management strategy in:
‐ 36.5% ‐ 38%
38% ‐ 49% of cases
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Changes shown to be similar across all cancer types.
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CLINICAL EFFECTIVENESSS OF PET
CLINICAL EFFECTIVENESSS OF PET
A 2010 study from Vancouver General Hospital showed that PET changed intended treatment plans in 50% of cases.
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CLINICAL EFFECTIVENESSS OF PET
CLINICAL EFFECTIVENESSS OF PET After a PET scan, NOPR studies also showed:
• Plans for surgical biopsy were eliminated in 70% of cases
• Further diagnostic procedures were cancelled in ‐ 77%
‐ 90% of cases
90% of cases
Suggests PET should be a first‐line diagnostic tool, not a last resort
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Purpose of Study
Purpose of Study
» determine the current state of PET in Canada
» examine the current barriers to expanding PET or i th
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increasing the utilization of PET » consider the strategies required for Canada to move g
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ahead into 21st century cancer imaging
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The Use of Positron Emission Tomography (PET) for Cancer Care Across Canada:
Care Across Canada: Time for a National Strategy
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FINDINGS
Canada is far behind the United States and Europe Canada
is far behind the United States and Europe
in adopting PET technology:
» Canada has 29 clinical PET scanners » Europe will have 742 PET scanners by 2013
» The United States currently has about 2,000 PET scanners
WHO – recommends a ratio of 2.0 PET scanners per million Canada’ss current ratio = 0.86
Canada
current ratio = 0 86
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PET Scanners in Canada
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QUEBEC
» 12 scanners in 12 locations
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» Lowest cost
» Over 50% of all scans in Canada
» Y2000 QC Government decision to make cancer care a priority
» 2001 report recommended adoption of PET
» Government deployed 12 scanners over the next 8 years
» Will continue to add PET to all nuclear‐medicine departments 16
Ontario
9 publicly‐funded, clinical scanners
Lowest number of PET scans Lowest utilization of clinical scanners Year 2001 report recommended no insured funding for PET
Clinical trials surrounded by controversy
2 Ombudsmen investigations In July 2009 Government announced that it would make PET
In July 2009, Government announced that it would make PET available to cancer patients – Ombudsman report unpublished
» BUT in 2010, Ontario carried out fewer scans than 2009
» Ontario influences other provinces to take the cheap route
Ontario influences other provinces to take the cheap route
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Factors to OVERCOME in Growing g
PET in Canada
1. Costs
• High operational ($2M/year) and capital costs ($3‐4M)
• High costs of FDG – radioactive component of PET
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Cyclotrons Producing FDG for PET
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Factors CONSTRAINING PET Growth in Canada
1. Costs
2. Infrastructure and Policy Framework
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Canada’s unique geography and population density
Health Canada’s regulation of FDG
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No national policies or indications for use of PET
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Concerns about overuse of PET without proper indications
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Factors CONSTRAINING PET Growth in Canada
1. Costs
2. Infrastructure and Policy Framework
3. Education and Training
3. Education and Training
» Physicians
» Cancer patients and general public
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» Conflicting visions about spending scarce healthcare dollars
» Shortage of trained & educated personnel
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Canada’s Road to Success
Canada’s Road to Success
• Canada has a history of leadership in nuclear medicine
Canada has a history of leadership in nuclear medicine
• Canada has the resources and the track record to deploy & standardize PET imaging at a national level
& standardize PET imaging at a national level
• Team Canada ― coordination among the provinces ― is the winning strategy
the winning strategy
• Education is KEY
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Canada at the Crossroads
Canada at the Crossroads
Canada lags far behind the rest of the world in cancer imaging
Canada has a duty to improve cancer care and investigate technologies that can be more clinically‐ and cost‐ effective
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Canada’s CHOICE
Move forward and adopt new technology OR
Maintain the status quo
Maintain the status quo
The choice is OURS
The choice is OURS 24
Susan D. Martinuk
D. Martinuk ‐‐ [email protected]
Tim Meyer ‐‐ [email protected]
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