Professional practice gaps and barriers to optimal care of renal cell carcinoma (RCC) among oncologists in the United States.

Abstract

404 Background: New therapies for advanced RCC have improved patient outcomes while increasing the complexity of care. We sought to quantify practice gaps and barriers to optimal care among oncologists treating patients with RCC at academic and/or community centers in the United States. Methods: In total, 248 oncologists were recruited for a 2-phase (qualitative/quantitative) study. Eligible participants who had fully completed either one of the 2 phases were included in the analyses (n = 169). In the first phase, participants (n = 27) completed a brief online case-based survey and a 45-minute telephone interview on the attitudinal, contextual, and behavioral factors that influenced diagnosis and treatment. Selected interviews were transcribed and analyzed through thematic analysis. In the second phase, participants (n = 142) completed an online survey including case vignettes. Respondents’ answers were compared with optimal answers based on National Comprehensive Cancer Network kidney cancer guidelines (version 1.2013) and evidence-based opinions of 2 RCC experts. Results: Forty-six percent of participants correctly identified all predictors of short survival/poor risk in RCC. Regarding treatment options for a poor-risk patient, 37.5% chose temsirolimus and 11% sunitinib, both felt to be reasonable options. In a scenario focused on dose and treatment modification in a patient with treatment-related hypertension, 34% selected a nonoptimal management option. In a scenario focused on the importance of recognizing clinical symptoms as a component of treatment decision making, 40% of respondents were in agreement with expert- and evidence-supported treatment approach. Detailed results of this analysis will be presented. Conclusions: This study revealed clinically relevant practice performance gaps that affect delivery of care and patient health outcomes. Not recognizing predictors of poor risk or the importance of evaluating clinical symptoms can result in missed opportunities to change treatment strategy, leading to suboptimal outcomes. These results will support design of educational programs and performance improvement interventions.