Understanding international variation in access to PET-CT for oncology diagnostics: An International Cancer Benchmarking Partnership (ICBP) study.


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Charlotte Lynch1,Irene Reguilon2,Deanna Langer3,Damon Lane4,Wai-Lup Wong5,Fergus McKiddie6,Andrew Ross7,Lorraine Shack8,Thida Win5,Christopher Marshall9,Mona-Elizabeth Revheim10,Bolette Danckert11,Sabina Dizdarevic5,Canice McGivern12,Anne Hazlett12,Cheryl Louzado13,Mark MacMillan8,Sam Harrison1
1Cancer Research UK, London, UK,2eConsult, London, UK,3Cancer Care Ontario, London, UK,4Pacific Radiology, New Zealand,5NHS England, London, UK,6NHS Grampian, Aberdeen, UK,7Canadian Association of Nuclear Medicine, Ottawa, Canada,8Alberta Health Services, Edmonton, Canada,9Wales Research and Diagnostic PETIC, Cardiff, UK,10Oslo University Hospital, Oslo, Norway,11Aarhus University, Aarhus, Denmark,12Belfast Health and Social Care Trust, Belfast, UK,13Canadian Partnership Against Cancer, Toronto, Canada

Abstract

Background

PET-CT is an important diagnostic tool within cancer care, with evidence supporting its specificity, accuracy and sensitivity in detecting tumours, metastatic spread, and treatment monitoring. Variation in access to diagnostics has been identified as a potential contributor to international cancer survival differences. This study is the first to our knowledge exploring the differences between PET-CT guidelines, capacity and issues surrounding effective service delivery.

Method

Mixed methods including quantitative data collection on 4 access metrics (capacity, use, cost, location) from existing administrative data in 17 jurisdictions across high-income countries (UK, Ireland, Norway, Denmark, Canada, Australia, New Zealand) from the year 2000 onwards. Capacity was measured by scanner quantity and waiting times; use was measured by the number of scans carried out annually in the general and cancer populations. Literature searches were performed for clinical indication evidence. Descriptive comparative analyses were produced of use, capacity and indication guidance for PET-CT services between jurisdictions.

Results

11/17 jurisdictions were able to provide complete data on scanner location and capacity.  Number of PET-CT scanners ranged from 0.05 to 0.66 per 100,000. Acquisition of scanners over time showed the greatest increase in Denmark, 0.02 scanners per 100,000 in 2007, to 0.66 in 2017. Indications ranged between jurisdictions, with potentially clinically important differences seen in recommendations for colorectal cancer staging and within recommendations for non-small cell lung vs small-cell lung cancers. Data access, sources and definitions surrounding PET-CT services varied significantly across ICBP jurisdictions.

Conclusion

The lack of international PET-CT data availability and service consistency may act as a barrier in monitoring and implementing effective PET-CT services internationally. There is an unmet need in capturing more consistent, richer data relating for PET-CT activity to facilitate sharing of best practice and improve future planning for healthcare provision. Availability of PET-CT should be considered as a proxy for investment in, and quality of cancer care.