Current perceptions and practice patterns of oncologists in managing patients with gastric cancer.

Abstract

60 Background: The management of gastric cancer is evolving with advances in the development of targeted therapies. This study was conducted to assess the current practice patterns in the management of patients with gastric cancer and identify gaps that may be addressed through educational initiatives. Methods: A survey composed of patient case vignettes designed to elicit practice pattern information on testing and treating patients with gastric cancer, and questions regarding attitudes towards gastric cancer management, was distributed electronically to medical oncologists currently practicing in the U.S. in March 2010; 126 were completed and included for analysis. Results: A lack of confidence was identified in appropriately staging, selecting appropriate treatment, or staying up-to-date with new therapies for gastric cancer with 44%-48% rating confidence as 7 or less on a 10 point confidence scale. Even more (66%) lack confidence in using molecular markers for treatment selection. Perceived levels of familiarity with these topics were rated similarly. In a case vignette of a patient with metastatic gastric cancer, most oncologists (84%) included HER2 testing to help inform treatment. However, a majority (54%) use HER2 testing for their patients with advanced gastric cancer infrequently (50% of the time or less). Also, almost half (44%) would not include H. pylori testing in an initial work-up for a patient whose biopsy confirmed gastric adenocarcinoma. In another case vignette, oncologists were more likely to select a surgery (61%) rather than a preoperative chemotherapy (39%) as supported by current evidence. Late detection is perceived as a significant barrier by 72% of oncologists in managing patients with gastric cancer. Conclusions: With the confidence and familiarity gaps of oncologists in managing patients with gastric cancer, the infrequent HER2 testing patterns, and lack of preoperative chemotherapy treatment, continued education in the latest evidence is needed. No significant financial relationships to disclose.