Abstract
BackgroundCytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is a treatment option for patients with peritoneal metastases shown to provide improved overall survival for appropriately selected patients. However, the availability and utilization of this treatment remains limited. The aim of this survey-based study was to evaluate factors influencing physician treatment choices for peritoneal metastases.MethodsSurveys were mailed to medical oncologists and surgeons in Virginia, Maryland, and Washington, D.C. Survey questions evaluated access to HIPEC centers, prior experience with referral to HIPEC centers, opinions regarding efficacy, and knowledge regarding outcomes of CRS and HIPEC.ResultsSurveys were mailed to 2279 physicians; 116 eligible surveys were returned. Seventy-five percent of respondents would consider referral to a HIPEC center for appendiceal peritoneal metastasis, while only 50% would consider it for colon cancer and peritoneal mesothelioma. The most common reason for never referring a patient to a HIPEC center was lack of access to a HIPEC specialist (47%) followed by perceived lack of evidence for the treatment modality (31%). Five-year survival after CRS and HIPEC was underestimated while 30-day mortality was overestimated by more than half of respondents.ConclusionsReferral to HIPEC centers is underutilized among community physicians in practice. Limited access to HIPEC experts is the most common cause for lack of referral, followed by a perception of insufficient evidence for this treatment approach. Lack of familiarity with data regarding outcomes impacts referral patterns and treatment choices. Possible actions to increase awareness and appropriate utilization of CRS and HIPEC are suggested.
Highlights
Peritoneal carcinomatosis has traditionally been approached with therapeutic nihilism and associated with very poor prognosis, with average expected survival of 6–12 months [1,2]
A recent consensus statement from the 9th International Congress on Peritoneal Surface Malignancies stated that Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) should be considered the treatment of choice for pseudomyxoma peritonei and appendiceal neoplasia with peritoneal carcinomatosis and the standard of care for selected patients with peritoneal mesothelioma and moderate to small volume peritoneal carcinomatosis secondary to colorectal cancer [5]
Our study shows that physicians who treat patients with gastrointestinal cancer, including those with peritoneal metastases, practice predominately in a community setting, see patients with peritoneal malignancy very infrequently, and may not frequently discuss their patients at a multidisciplinary tumor board
Summary
Peritoneal carcinomatosis has traditionally been approached with therapeutic nihilism and associated with very poor prognosis, with average expected survival of 6–12 months [1,2]. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) has evolved as a treatment option for patients with peritoneal carcinomatosis and has shown significantly improved survival for appropriately selected patients with peritoneal metastases from appendix and colon cancer, peritoneal mesothelioma, ovarian, and other malignancies [3,4]. We performed a formal literature search on the topic and found that there are no published studies investigating physician knowledge of CRS and HIPEC or factors that may influence treatment choices in patients with peritoneal metastases in the United States. Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is a treatment option for patients with peritoneal metastases shown to provide improved overall survival for appropriately selected patients. The availability and utilization of this treatment remains limited The aim of this survey-based study was to evaluate factors influencing physician treatment choices for peritoneal metastases. Possible actions to increase awareness and appropriate utilization of CRS and HIPEC are suggested
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