Comparison of medical oncologists' approach to non-small cell lung cancer patients compared with breast cancer.

Abstract

6601 Background: Despite recent advances in the management of non-small cell lung cancer (NSCLC), treatment disparities persist. Evidence suggests that primary care physicians (PCPs) have less awareness of the benefit of adjuvant chemotherapy for lung cancer compared to breast cancer. They may also be less inclined to refer advanced stage NSCLC patients for further treatment and closely manage pain. This study’s goal was to refine this focus on treatment comparisons with a survey of medical oncologists. Methods: Online case scenarios were provided to medical oncologists identified through participating state and institutional organizations. Medical oncologists were randomized to receive one of four scenarios on the basis of cancer type (lung v. breast) and smoking status (30 pack/year smoker v. lifetime non-smoker). Medical oncologists’ treatment approaches were compared. Results: Two hundred seventy-one medical oncologists participated in the survey. The majority were male (71%) with a mean of 16.5 practice years; 28% worked within an academic setting. There were no significant differences in adjuvant chemotherapy use for early stage patients (98.3% lung v. 98.4% breast) or second-line chemotherapy for progressive disease (93.7% lung v. 95.9% breast). Almost all medical oncologists reported that they would offer an available clinical trial to a patient who had progressive disease but a good performance status (PS), regardless of cancer type. However, more medical oncologists were “very likely” to start third line chemotherapy for advanced stage breast cancer (33.6%) compared to advanced stage NSCLC (18.4%; p=.01). Conclusions: Medical oncologists report consistent first- and second-line adjuvant treatment patterns for NSCLC compared to breast cancer. However, they are less likely to consider third-line chemotherapy for advanced stage NSCLC, suggesting subtle treatment disparities. This study was supported by an award by GlaxoSmithKline (GSK) and by a grant from the National Lung Cancer Partnership and its North Carolina affiliate.