Do future innovations in development influence oncologists’ treatment recommendations today? A survey of U.S. oncologists.

Abstract

e24004 Background: Survival benefit from current anticancer treatments, even if modest, improves a patient’s chances of accessing and benefiting from future innovations currently in clinical development. No studies to date have evaluated the potential impact of future innovations on oncologists’ treatment recommendations. Methods: We conducted a national survey of medical and hematologic oncologists (n = 200) on how expectations about future innovations may influence their treatment recommendations today. The survey described a hypothetical patient with metastatic cancer, whose median overall survival (OS) was approximately 6 months with most dying within 2 years. We presented four alternative hypothetical scenarios of new innovations in the clinical development pipeline with varying (a) expected efficacy—“modest” (improvement in median OS of 2 months} or “breakthrough” (improvement in median OS of 6 months) and (b) time of arrival (in 6 months or 1 year). We asked the oncologists about the likelihood (using a 5-point Likert scale) (1) that they would discuss these new innovations with the hypothetical metastatic patient, and (2) that these new innovations would influence their recommended treatment for the patient today. We descriptively summarized percentages of oncologists who responded “likely” or “very likely” and examined their associations (using multivariate logistic regression) with the expected efficacy and time of arrival of future innovations as well as the characteristics of oncologists and their practice. Results: When future innovations were expected to have modest efficacy and arrive in 6 months, 61% of oncologists reported that they would be likely or very likely discuss them with their patients, and 52% reported new innovations would influence their treatment recommendations today. With modest efficacy and time of arrival in 1 year, percentages dropped to 49% and 41%, respectively. With breakthrough efficacy and arrival in 6 months, 76% would discuss and 68% would consider new innovations. With breakthrough efficacy and arrival in 1 year, percentages dropped to 62% and 55%, respectively. Greater expected efficacy and shorter time to arrival were associated with a significantly greater likelihood of discussing a future innovations with patients across oncologist and practice characteristics (adjusted odds ratios: breakthrough vs. modest = 1.75; 6 month vs. 1 year = 1.72). Conclusions: Future treatment innovations in clinical development are relevant for decision-making today even when anticipated time to arrival is two times the current median OS. results indicate that it is important to include future innovations in shared decision-making in addition to the benefit-risk balance of current treatments.