Oncology patients through the eyes of their physicians.

Abstract

e18757 Background: There is a continuous need for optimizing and rationalizing cancer care according to national and international guidelines. The aim of the survey is exploring the thoughts and expectations of oncologists worldwide regarding their patients' management and prognosis and the factors affecting these expectations. This survey shed light on the oncologists' side of the relationship with their patients, which is often ignored. Methods: This is an observational cross-sectional study via an online pre-tested self-administered survey, targeting subspecialties of Oncologists across the world. Results: Among 929 Oncologists who completed the survey, 50.7% worked at University hospitals. They came from 17, 27, 23 and 14 countries in Africa, Asia and Australia, Europe, and the Americas respectively. Our results showed that, 58.7% thought stage of the disease is the most important factor affecting the prognosis. Additionally, 34.4%, 21.4% and 14.2% agreed that the 2nd most important factor was Performance status, stage of the disease, and disease pathology and immunohistochemistry respectively. Also 63% agreed that targeted therapy improves their expectations of the outcomes in eligible patients. While, 56% agreed that Immunotherapy improves their expectations. Only 42.3% indicated that they always inform patients of the detailed management plan and only 20.7% agreed that they always inform advanced cases about their incurable disease. Moreover, 52% usually expect the patients to fully understand the detailed management plan, but only 7% always expect that. The main factor affecting this is the patients’ education level as indicated by 76% of the respondents. The 2nd leading cause is that patients usually have some degree of denial as indicated by 35%, followed by patients’ unrealistic expectations as indicated by 30% of oncologists. Results also showed that 63.5% always inform their patients about all adverse events of their therapy directly, and 59% agreed that patients usually accept them, but only 6.5% indicated that patients always accept them. The fear of death or possible disabilities are the main factors causing some patients to reject these adverse events as indicated by 52%, while 31% thought fear of the looming social or financial difficulties is the main cause. The majority agreed that patients are either always (33%) or usually (46.9%) open to their case being discussed in Multidisciplinary clinics. Contrarily, only 5.3% indicated patients are always open to being referred to Psychiatrists. The majority agreed that patients are open to being referred to nutritionists or non-oncology physicians. However, only 19% and 7% agreed that patients are always open to being referred to Palliative care and Hospice respectively. Conclusions: The survey shows that oncologists worldwide have consistent evidence-based prognosis. Contrary to that, it shows widely varying perceptions regarding the patients’ reactions, due to variable factors.