Identifying best support care patients in an outpatient medical oncology unity: difficulties presented by training medical oncologists

Abstract

20613 Background: the large increase in the number of new drugs and technologies requires that oncologists correctly identify pts who are candidates for BSC, to provide appropriate symptom control and avoid futile aggressive treatments to poor prognosis patients who do not benefit from them. It may be particularly difficult to young medical oncologists in training to identify these patients. We conducted a survey between medical oncology residents to measure their perception of patients not able to receive chemo, radio or hormonal therapy for advanced cancer. Methods: For a week, questionnaires were answered by medical residents at the end of all outpatient consults in an adult, solid tumor medical oncology unit, in a public university hospital. A score was applied to identify patients that could be candidates to BSC, and this data was compared with the actual treatment given. Results: Questionnaires were answered in 200 (95,2 %) medical consults done in a week at the unit. Median age was 56.5 ± 14 years (range 18 - 89), 131 (65.5 %) patients were female and 69 (34.5 %) male. Primary tumor sites were mainly breast (75; 37.5 %), colorectal (43; 21.5 %), head and neck (24;12.0 %), lung (18; 9.0 %), and gynecological (13; 6.5 %). ECOG was 0 in 70 (35%), 1 in 76 (38 %), 2 in 41 (20.5 %) and 3 in 13 (6.5 %) pts. Out of the 200 cases, 26 (13%) were scored as candidates to BSC. However, while 126 (63%) patients received radio/chemo or hormonal therapy, only 8 (4%) were referred to BSC. From 93 (46.5 %) stage IV pts, 11 (12%) were considered potentially curable by the residents. Conclusions: Medical oncology residents have difficulties identifying BSC candidates among patients with advanced cancer. Development of appropriate skills and application of algorithms to identify BSC pts may be necessary to better control symptoms and avoid unnecessary treatments. No significant financial relationships to disclose.