Radioimmunotherapy in Non-Hodgkin Lymphoma: Opinions of U.S. Medical Oncologists and Hematologists

Abstract

Radioimmunotherapy is approved by the Food and Drug Administration for CD20 antigen-positive follicular and transformed non-Hodgkin lymphoma. The goal of this study was to obtain the opinion of hematologists and medical oncologists about CD20-directed radioimmunotherapy in the United States. An e-mail-based survey with 8 questions was sent to 4,239 oncologists and hematologists throughout the United States. Two hundred sixteen (5.0%) oncologists and hematologists responded to our survey. One hundred fifty-seven (72.7%) said they had referred patients with non-Hodgkin lymphoma for radioimmunotherapy in the last 24 mo. Different types of practices had significantly different concerns regarding this treatment. Compared with referring physicians from academic centers, those from nonacademic centers reported significantly higher concerns about the lack of a site to which to refer patients for treatment (P < 0.01), the lack of interest by nuclear physicians in this type of treatment (P < 0.01), and a referral process that they felt was too complicated (P < 0.01). They were also more concerned about an economically adverse effect on their own practices if they referred patients for radioimmunotherapy (P < 0.01). Referring physicians who perceived consolidation as a possible indication for radioimmunotherapy had significantly fewer concerns about an adverse effect on their own practice (P < 0.01) and about nonradioactive alternatives (P < 0.01). Seventy-nine (36.6%) responders thought radioimmunotherapy would probably grow in importance, and 52 (24.1%) responders thought it would definitely grow in importance. However, the group with a positive outlook about the future of radioimmunotherapy predicted a higher growth of radioimmunotherapy if they could administer it in their own offices (P < 0.05). Radioimmunotherapy was generally viewed positively by referring physicians. However, in addition to scientific concerns, barriers to the use of radioimmunotherapy included difficulty in referral, perceptions of a high cost of the treatment, concerns about negative financial outcomes related to referral, and an opinion that the treatment would be used more if given by medical oncologists in their own offices. For the growth of radioimmunotherapy, it appears crucial not only to demonstrate the treatment's safety and efficacy but also to streamline the referral process, to enhance collaboration between specialists, and-it appears-to develop economic incentives for the referring physician.