Oncologists', physicians' and surgeons' opinions on the perceived value and appropriateness of the speciality to inform patients on adjuvant chemotherapy after radical surgery for non-small cell lung cancer.

Abstract

7011 Background: The benefit of chemotherapy after surgery for lung cancer is established, but roles and responsibilities of discussing adjuvant chemotherapy are not established. Whilst risks are straight forward to convey, difficulties in conveying the benefit results from published hazard ratios as the benefit varies with stage and therefore needs to be calculated individually and conveyed in a language that is understood by the patient. Methods: From 2010 to 2011, a survey was conducted of cancer physicians, oncologists and surgeons in the UK. Clinicians asked to rank the most appropriate speciality to discuss adjuvant chemotherapy with patients, to calculate expected survival given baseline survival probability of 80% and a hazard ratio of 0.80, and then surveyed for the additional expected gain in cohorts with a 5 year survival probability of 40%, 60% and 80% respectively before they would recommend adjuvant chemotherapy Results: A total of 202 responses were received from 27 surgeons, 77 physicians, 87 oncologists (11 unstated). The majority of 56% of surgeons, 79% of physicians and 61% of oncologists felt an oncologist as the most appropriate initial clinician to discuss adjuvant chemotherapy with patients after surgery. In total 33% of surgeons, 53% of physicians and 73% of oncologists were able to correctly calculate the expected survival of patients. When asked about perceived value before considering recommending adjuvant chemotherapy with 5 year survival probabilities of 40%, 60% and 80%, clinicians reported an expected a mean gain (SE) of 20.8% (2.7), 15.6% (2.4) and 13.2% (2.1) against an expected of 12%, 8% and 4% respectively with a hazard ratio of 0.80. Conclusions: Our survey suggest oncologists as the clinicians best able to calculate the individual benefit of adjuvant chemotherapy and the majority of specialities polled agreed oncologists as the most appropriate initial person to discuss adjuvant chemotherapy with patients after radical surgery for lung cancer. The perceived value prior to recommending adjuvant chemotherapy in clinicians greatly exceeds current published results.