The NCI awarded nearly $4 million over 2 years to support the development of a Center for Comparative Effectiveness in Cancer Imaging that will explore whether emerging imaging technologies are improving cancer detection and treatment.
This multi-institutional study combines the expertise of researchers from the Norris Cotton Cancer Center at Dartmouth College in Hanover, New Hampshire; the Dartmouth Institute for Health Policy and Clinical Practice; the American College of Radiology Imaging Network (ACRIN) statistical center at Brown University in Providence, Rhode Island; the Tufts Medical Center Evidence-based Practice analyze Center in Boston, Massachusetts; Virginia Commonwealth University in Richmond, Virginia; and Washington University Medical Center in St. Louis, Missouri.
Researchers will advance CER methodologies for existing trials and also develop future research. Specific projects will be based on the National Lung Screening Trial and the National Oncologic PET Registry.
“One of the big questions we're trying to answer is how these technologies are being used and how they affect costs and outcomes,” says Anna Tosteson, ScD, professor of medicine at Dartmouth Medical School, and 1 of 3 principal investigators on the grant “A lot of the clinical studies that have been done so far have had a limited time frame and a limited number of participants.” She points to the ACRIN study comparing film and digital mammography in which participants were followed for only 1 year To further the results of such time-limited clinical trials, researchers will need to develop mathematical models with which to make projections regarding health outcomes overtime.
Some of the center's work will involve characterizing the impact of specific clinical trial findings as well as developing quality-of- life and cost-effectiveness evaluations for future studies. Researchers also are reviewing Medicare claims data to determine how specific imaging technologies are used. For example, CMS only covers positron emission tomography (PET) scans for cancer if patients participate in the National Oncologic PET Registry. The referring physician is required to say what the intended care plan is before and after the imaging is performed. “We're looking at the pattern of claims to see if the recommended care plan actually was used and whether it's good enough to ask what the intended care plan is or more information is needed,” Dr Tosteson says.
Researchers also are examining the use of PET scans for surveillance of suspected disease recurrences, which is not routinely covered by insurance. They are studying the nature of these surveillance findings in patients with lymphoma as well as colorectal and head and neck cancers and whether they will positively or negatively affect outcomes. “We're focusing on the method, approaches, and infrastructure for research with the long-term objective of putting into place approaches to understand how cancer care is affected by these new technologies,” she says.