We have previously reported that PET using ¹⁸F-fluoride (NaF PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF PET results and hospice claims within 180 d and 1-y survival. Methods: We classified NOPR NaF PET results linked to Medicare claims by imaging indication (initial staging [IS]; detection of suspected first osseous metastasis [FOM]; suspected progression of osseous metastasis [POM]; or treatment monitoring [TM]) and type of cancer (prostate, lung, breast, or other). Results were classified as definitely positive scan findings versus probably positive scan findings versus negative scan findings for osseous metastasis for IS and FOM; more extensive disease versus no change or less extensive disease for POM; and worse prognosis versus no change or better prognosis for TM, based on the postscan assessment. Our study included 21,167 scans obtained from 2011 to 2014 of consenting NOPR participants aged 65 y or older. Results: The relative risk of hospice claims within 180 d of a NaF PET scan was 2.0–7.5 times higher for patients with evidence of new or progressing osseous metastasis than for those without, depending on indication and cancer type (all P < 0.008). The percentage difference in hospice claims for those with a finding of new or more advanced osseous disease ranged from 3.9% for IS prostate patients to 28% for FOM lung patients. Six-month survival was also associated with evidence of new or increased osseous disease; risk of death was 1.8–5.1 times as likely (all P ≤ 0.0001), with percentage differences of approximately 30% comparing positive and negative scans in patients with lung cancer imaged for IS or FOM. Conclusion: Our analyses demonstrated that NaF PET scan results are highly associated with subsequent hospice claims and, ultimately, with patient survival. NaF PET provides important information on the presence of osseous metastasis and prognosis to assist patients and their physicians when making decisions on whether to select palliative care and transition to hospice or whether to continue treatment.

我们先前曾报道称，使用¹⁸ F-氟化物（NaF PET）评估骨转移性疾病的PET与参与国家肿瘤PET注册（NOPR）的Medicare受益人的预期治疗有实质性变化。在这里，我们使用Medicare管理数据来检查NaF PET结果与180 d和1 y生存期内的临终关怀声明之间的关联。方法：我们通过影像学指征（初始分期[IS]；可疑首次骨转移[FOM]的检测；可疑骨转移[POM]的进展；或治疗监测[TM]）对与医疗保险声明相关的NOPR NaF PET结果进行了分类和癌症类型（前列腺，肺，乳房或其他）。结果归类为IS和FOM骨转移的肯定阳性扫描结果与可能阳性扫描结果与阴性扫描结果。与POM相比，更广泛的疾病而不是改变或更不广泛的疾病；根据扫描后评估，TM的预后较差，TM则无变化或预后较好。我们的研究包括从2011年到2014年对65岁以上的NOPR同意受试者进行的21,167次扫描。结果：根据适应症和癌症类型，在有NaF PET扫描的180天内，有新骨转移或进展骨转移的患者的临终关怀要求的相对风险要比没有骨转移的患者高2.0-7.5倍（所有P <0.008）。发现新骨病或晚期骨病者的临终关怀要求百分率差异从IS前列腺癌患者的3.9％到FOM肺病患者的28％不等。六个月的生存期还伴有骨病新发或增加的证据；死亡的风险是1.8-5.1倍，可能（均P ≤0.0001），与患者的成像为IS或FOM肺癌比较正面和负面的扫描大约30％的百分比差异。结论：我们的分析表明，NaF PET扫描结果与随后的临终关怀声明以及最终与患者生存高度相关。NaF PET可提供有关骨转移和预后的重要信息，以帮助患者及其医师决定是否选择姑息治疗和过渡至临终关怀或是否继续治疗。