P-335 Self-reported prescribing practices in the setting of adjuvant treatment for colorectal cancer

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The Short Course Oncology Treatment (SCOT) trial demonstrated non-inferiority of 3 versus 6 months of adjuvant treatment for colorectal cancer (CRC). It was the largest contributor to the Duration of Adjuvant Chemotherapy for Stage III Colon Cancer (IDEA) Collaboration. The aim of this study was to explore the impact of these results on clinician prescribing one-year post-publication. An online survey was developed and piloted using OnlineSurveys®, and was disseminated using email, an ESMO GI mailing list, and Twitter® in April 2019. Descriptive statistics were used for the main analysis and Chi2 tests for comparison of proportions. In total, 265 clinicians from 21 countries responded. Most were oncologists (97%) and worked in non-academic roles (63%). Response rate was 51% for UK consultant oncologists. Most (91%) were aware of the SCOT trial or IDEA collaboration results, and 94% of these clinicians reported a corresponding practice change. Listening to conference presentations of trial results was the most common (30%) mechanism of dissemination which influenced practice change. There was a clear division in the approach to treatment based on stage III CRC risk group. In total, 78% of clinicians used 3 months of CAPOX for patients with low-risk stage III CRC (T1-3N1) versus 15% for high-risk disease (T4 or N2 disease) (p< 0.001). Most clinicians (69%) preferred to use 6 months of either CAPOX or FOLFOX for high-risk stage III CRC, whereas only 4% used this strategy for low-risk disease (p< 0.001). UK clinicians were more likely to choose CAPOX when giving 6 months of doublet chemotherapy for high-risk stage III CRC (68% CAPOX, 32% FOLFOX p< 0.001), however, this preference was not apparent for non-UK clinicians (48% CAPOX, 52% FOLFOX p=0.302). Overall, there was more heterogeneity in practice for patients aged over 70 compared to younger patients, and for patients with stage II versus stage III CRC. In total, 91% of respondents agreed that 3 months of CAPOX could be considered standard care for patients with low-risk stage III disease versus 44% for high-risk stage III disease. Using 3 months of FOLFOX was a less favourable option for both stage III risk groups. There was most uncertainty regarding stage II disease, with 23% of clinicians indicating they were unsure about using 3 months of doublet chemotherapy in this situation. Approximately half of patients with CRC present with stage II or stage III disease at diagnosis. It is therefore paramount to know how these patients are treated in real life. This survey shows that the SCOT trial and IDEA collaboration can be considered practice-changing. Despite SCOT meeting its non-inferiority end-point in the overall trial population, clinicians are using sub-group analyses to guide treatment. Clinicians are more reluctant to use a shorter duration of doublet treatment for high-risk compared to low-risk stage III CRC, and rarely use 3 months of FOLFOX for any disease stage. This survey will be repeated in April 2020 to explore if and how practice has altered over time.