Patients in rural communities struggle to access newer tumor-targeting radiotracers
New findings suggest that the introduction of newer neuroendocrine-targeting radiotracers may have created access barriers for certain patient demographics.
A paper published Wednesday in the Journal of the American College of Radiology details data compiled by the Harvey L. Neiman Health Policy Institute regarding the accessibility of gallium-68 dotatate/dotatoc radiotracers. These tracers are used to visualize and, in some cases, treat neuroendocrine tumors.
Introduced in 2017, the newer tracers are PET-based, rather than SPECT-based like their predecessor indium-111 pentetreotide (Octreoscan). One pitfall of the tracer, however, is that gallium-68 has a very short half-life of 68 minutes, which limits its accessibility. This, authors of the new paper contend, has created barriers for patients in more rural areas.
“PET/CT-based imaging with gallium-68 can only be performed when the radiotracer is produced locally due to its extremely short half-life. For this reason, patients living in small-rural areas had to travel long distances,” said lead author Cindy Yuan, MD, assistant professor of clinical radiology at the Indiana University School of Medicine. “We found that the introduction of gallium-based radiotracers resulted in substantial access differences.”
Yuan and colleagues conducted a retrospective analysis of Medicare claims for Indium-111 pentetreotide (Octreoscan), ga-68 dotatate/dotatoc (gallium), and 64-cu-dotatate (copper), which has a longer half-life of more than 12 hours. The group used patients’ home address and the treating facility’s location to calculate the distance traveled for their exam to compare how easily accessible it was for rural versus urban residents.
There were nearly 250,000 claims included in the analysis. In 2017, exams with gallium accounted for approximately 33% of all claims. By 2020, this figure rose to over 90%. Similarly, studies using copper-based tracers increased from 21% in 2021 to 40.6% in 2023 but was utilized more often in rural areas. When gallium-based tracers were the only option, rural patients had to travel upward of 130 miles further for their exam than they would have if Indium-111 pentetreotide were the agent of choice. The introduction of 64-cu-DOTATATE (copper) resulted in significantly lower commutes for patients.
“Importantly, the introduction of copper-64 DOTATATE in 2021 largely eliminated the metropolitan-micropolitan versus small-rural differences in access to PET-based radiotracers,” Yuan added. “Patients still traveled a little farther for PET-based radiotracers than for Indium-111 pentetreotide, likely reflecting the geographic availability of PET scanners, but the willingness to travel farther is likely due to the clinical superiority of PET-based radiotracers.”
Though the gallium-based tracers have more diagnostic benefits compared to copper-based tracers, Yuan suggested that the latter should not be overlooked for patients in rural areas.
“Given these realities, it may be beneficial to continue using gallium-68 in larger markets where its local production costs may be more broadly diffused, while using copper-64 in smaller markets may facilitate substantially broader access for small-rural patients,” she noted.
Read more from the study here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.