Blood cancers

Haematologists want access to PET/CT for neutropenic fever

Haematologists want better access to PET/CT to investigate febrile neutropenia in patients with haematological malignancies, an Australian survey shows.

PET/CT is rated as useful for diagnosis of neutropenic fever (NF) and also for investigation of prolonged NF, but most clinicians have difficulty accessing it in a timely way, according to a survey of haematologists and infectious disease physicians managing infections in immunocompromised patients.

A survey of 145 clinicians (25 haematologists and 120 infectious disease specialists) found that half had experience of using PET/CT for infection indications and 77% believed it to be useful.

However only 63% had onsite access to PET/CT and even when it was available more than half (54%) of haematologists could not access it within three days. Cost, lack of reimbursement and long waiting times were cited as the main barriers to access to PET/CT for infection indications.

None of the  haematologists surveyed said they would use PET/CT upfront for prolonged NF, but 56% said they would like to use it for prolonged NF if CT was negative.

The study authors said PET/CT was increasingly recognized as a beneficial diagnostic test in patients with haematologic malignancy with NF, as it could guide decisions on antimicrobial therapy and investigations such as bronchoscopy or tissue sampling.

“There is a strong desire among surveyed Australian clinicians to use PET/CT for prolonged NF and potential invasive fungal infection. However, access to PET/CT is a current barrier to uptake,” they wrote in the journal Leukaemia and Lymphoma.

Clinicians would need to provide evidence of benefit from trials of PET/CT to justify a new diagnostic pathway in NF, they suggested

A study comparing PET/CT to conventional CT in the management of high-risk NF (The PIPPIN study) is currently underway, and will report findings later in 2019, they noted.

“Improved outcomes in the PET/CT arm would be a driver for expanded reimbursement indications for PET/CT and increased numbers of PET/CT scanners, both of which would remedy some of the access issues described here, the authors suggested.

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