PET scanner It's known as PET, it looks for cancer, and in its first year of use, doctors changed the treatment planned for 45 percent of patients scanned.
helps improve
cancer care,
isle study finds
Queen's PET scanner can
detect tumors earlier and
show how extensive they are
By Helen Altonn
Star-Bulletin"To our surprise, we had a tremendous effect on care of patients," said Dr. Marc Coel, chief of the Nuclear Medicine Department at the Queen's Medical Center.
PET is short for Positron Emission Tomography, a powerful multimillion-dollar scanner donated to Queen's in 1998 by Hamamatsu Photonics K.K. of Japan.
The Hamamatsu/Queen's PET Imaging Center wants to make sure what it is doing is appropriate for patients, Coel said, so follow-up is done with them after scans to check results.
A database was established when the imaging center opened and information recorded on every patient. Among the information included was whether physicians had changed intended treatment and if the scan results affected their decision.
Coel asked Dr. Robert Tucker, Queen's postdoctoral fellow, to study results on 463 cancer patients who underwent the whole-body scan in the first year, from October 1998 to October 1999.
Lung, head and neck, and colorectal cancers were the leading causes of referral to the imaging center.
The results, reported in this month's issue of the Journal of Clinical Oncology, show PET overall had a positive influence in 89 percent of the cases.
A lung specialist and a cancer surgeon also reviewed a sample of 53 cases -- mostly lung cancer -- taken from the 463 cases.
That review found the scans were useful in 96 percent of the cases; in 33 percent, surgery was canceled after doctors reviewed the scan results; in 15 percent, chemotherapy or radiation was added to the treatment plan.
And in 7 percent of patients in the sample, treatment was canceled because the PET scan found they did not have cancer.
Based on the results, Tucker said PET "should become an integral part of a physician's diagnostic work-up of a suspected cancer patient and a routine exam for those with cancer."
Coel said: "One thing we know from this study is that it helps patients. Now the question for society is, Is it worth the cost?"
That question may soon be answered, with the Hawaii Medical Service Association Foundation funding a 2 1/2-year study led by Tucker to pursue that issue. The study will compare treatment costs of patients who have PET scans with those who do not.
Although PET scans are expensive, Coel said, they could save money by eliminating unnecessary surgery and recovery costs. Patients also could get earlier chemotherapy or radiation treatment rather than be "left and watched," he said. To check how far a cancer has spread, patients are given radioactive glucose. Because cancers have increased sugar metabolism, the glucose is absorbed in the cells, and PET's 22,000 detectors pick up signals from the radioactive glucose.
"These tumors will just stand out as bright," Coel said. PET is very sensitive, he said. "It can detect (tumors) earlier and tell how extensive they are. That's very important for determining how a patient will be cared for."
If the cancer has spread beyond surgical removal, he said, "we can save risks and discomfort of surgery and get them on chemotherapy or radiation sooner.
"What we also found is, (some) patients who were not supposed to be surgical candidates actually are, so they could be cured by surgery. So we have the flip side, which is a great benefit to people."
Coel's group had guessed that doctors changed treatment in 10 percent to 20 percent of the 463 cases reviewed, so the 45 percent was "a pleasant surprise," Coel said.
He said scans changed the course of care in 50 percent of lung cancer cases and 60 percent of colon cases.
Instead of just looking at cells, doctors and scientists will be looking at how they work, he said. "Something can look malignant and it's not, or something can look like it's benign, and it's malignant.
"It may be hidden by another piece of tissue," he said. "Or maybe scar tissue, after you've killed cancer, may look like residual things. We can differentiate these things (and) look at what's happening inside."
Coel said the biggest problem is educating physicians to use the PET scan early enough and to trust it.
However, he said patient response has been tremendous. "We get patients calling us for scans," he said. "They learn about it from the Internet and TV. We refer them back to their doctors. But sometimes they are first to initiate use of PET."
Medicare covers lung, colon, head and neck cancer, melanoma, lymphoma and esophagus scans, Coel said.
He is hoping coverage will be extended in the fall for breast cancer and Alzheimer's disease.
"We can predict earlier than the symptoms (appear) if a person will develop Alzheimer's and get them on medications to slow the progress," he said.
Many insurance companies follow Medicare's lead on coverage, but HMSA was ahead of it with coverage for 10 types of cancers, excluding breast cancer, Coel said.
The imaging center gets interesting cases that are not normally related to its work, Coel noted, such as patients suffering with chronic fatigue syndrome asking for scans on the brain to see if something is abnormal.
"It's a whole new line of research," he said. "Nobody knows anything about it."
He said the center also has been asked to participate in various national research projects on lung cancer and brain function.
A sleep deprivation study has also been proposed to find out how the brain works and how function can be improved for soldiers, interns, firemen, police, pilots and others often deprived of sleep in work, he said.
Joni Paahao, 48, said she did not hesitate when a Positron Emission Tomography scan was suggested to her after she was diagnosed as having breast cancer. PET helped give
peace of mind
to cancer patient
after diagnosis
By Helen Altonn
Star-BulletinShe was one of the first patients to benefit from a PET scan after the machine was set up at the Queen's Medical Center in 1998. "Based on the information they provided me, it seemed a simple enough procedure," Paahao said. "It helped minimize my concerns, if the cancer had spread to other parts of the body."
Paahao, vice president for sales and marketing for Aston Hotels, said she was on her way back from a mainland business trip when she felt a lump in her left breast.
The next day, she went to a doctor and was diagnosed a few days later with breast cancer, "which of course put me into shock.
"I have to say for probably the first week, I was just kind of struggling through disbelief and all those emotions." She said her doctor introduced her to Dr. Marc Coel, chief of Queen's Nuclear Medicine Department.
"It was very comforting to me, because once you detect breast cancer, you have to go through a whole bunch of other tests to make sure it's not in other parts of the body," she said.
She went through all the tests, she said, but "the quickest, easiest and most painless was the PET scan."
It confirmed she had breast cancer but that it had not spread. "It was immediate relief," Paahao said, "because initially, when you hear the big C -- and in my case I wasn't really educated about it, much as I had heard about it -- you never think it will ever happen to you.
"At that time there are so many emotions you are working through and dealing with -- survival, the need to make decisions about treatment and about surgery -- and it's a real difficult period. I think the PET scan provided me with peace of mind."
She said she would like to have an annual PET scan to make sure the cancer has not spread, but her insurance (HMSA) does not cover it.
She underwent chemotherapy and radiation for about nine months after the 1998 scan and says she is "OK" now.
"My life has returned to normal," she said. "Of course, I think I have a better outlook on life, greater appreciation for friendships, relationships and the people that I love."
They include her parents, Marilyn and Ronald Chun, and her son, Pono, 22, a senior at the University of Washington.
"It's all connected," she said. "My challenges were shared by them out of love and support. It doesn't just minimize concern and provide relief for me, but certainly for those who care for me."