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The Ovarian Cancer National Alliance Plays Significant Role in Advocating PET Scan coverage for Medicare Patients Friday, April 3, 2009 (WASHINGTON, DC):

The Centers for Medicare & Medicaid Services (CMS) announced its decision earlier today to cover Positron Emission Tomography (PET scan) for ovarian cancer patients. In contrast, many other cancer patients who receive care through Medicare will be covered for only one PET scan as part of initial treatment strategy development. Those patients can receive subsequent PET scans from Medicare only through a large clinical trial designed to collect data for a process known as Coverage with Evidence Development (CED). Ovarian cancer is an exemption to this decision and ovarian cancer patients will be able to access PET scans whenever their providers determine that it is medically necessary in the context of subsequent treatment strategy. The Ovarian Cancer National Alliance worked diligently with CMS and the cancer community to ensure that CMS’s decision supported ovarian cancer patients and is pleased with the resulting decision. CMS already provides full coverage of PET scans for nine types of cancer: breast, cervical, lymphoma, melanoma, non-small cell lung, colorectal, esophageal and head and neck cancer. This coverage will be continued.

The Ovarian Cancer National Alliance was the only cancer patient advocacy group to testify at the Medicare Evidence Development and Coverage and Analysis Group meeting in August 2008. Cara Tenenbaum, Senior Policy Director for the Ovarian Cancer National Alliance, participated in the hearing. Tenenbaum noted that, “Our organization supports all evidence-based medicine and believes PET scans are a proven method for ovarian cancer patients when it comes to treating women who need restaging and or monitoring for recurrence or response to treatment. CMS’s decision today will aid doctors and patients in having a full and accurate measure of ovarian cancer, not only assisting with more accurate treatments, but ultimately helping to save lives.”

The National Oncologic PET Registry (NOPR) was a driving force behind the recent CMS decision because it proved thorough medical evidence that PET scans play a significant role in treating patients with cancer. The NOPR data showed that one-third of its PET scans led doctors to a change in treatment. For ovarian cancer patients, the data from the NOPR supports what patients already know – that PET scans are incredibly useful for restaging and monitoring recurrence: Overall, for the more than 4,500 ovarian cancer patients who had PET scans through the NOPR for any reason, approximately 40 percent had a change in treatment decision based on the results of the test.

The decision reads: CMS has reviewed evidence on the use of FDG PET imaging to determine subsequent treatment strategy in patients with ovarian cancer. CMS has determined that the available evidence is adequate to determine that FDG PET imaging improves physician decision making in the determination of subsequent treatment strategy in Medicare beneficiaries who have ovarian cancer, improves health outcomes and is thus reasonable and necessary under§1862(a)(1)(A) of the Act. Therefore, CMS has determined that FDG PET imaging is nationally covered for this indication for this tumor type.

There is no reliable early detection test for ovarian cancer, a tumor which seeds and spreads easily throughout the peritoneal cavity. It is often difficult to measure response to treatment, the spread of the disease and possible recurrences. PET scans were considered so effective by doctors, that almost as many ovarian cancer patients were scanned through the NOPR as prostate cancer patients, even though there are 11 times more prostate cancer diagnoses per year than ovarian cancer diagnoses. To learn more about the CMS PET scan announcement today or if you have additional questions, please contact Cara Tenenbaum, Senior Policy Director for the Ovarian Cancer National Alliance, by phone at 202.331.1332 or email at ctenenbaum@ovariancancer.org.