Perceptions Of Oncologists Research Articles

Conflict of Interest Disclosure in Oncology: Preliminary Insights From the Global ONCOTRUST-1 Cross-Sectional Study.

Conflicts of interest (COIs) between oncologists and industry might considerably influence how the presentation of the research results is delivered, ultimately affecting clinical decisions and policy-making. Although there are many regulations on reporting COI in high-income countries (HICs), little is known about their reporting in low- and middle-income countries (LMICs). Oncology Transparency Under Scrutiny and Tracking (ONCOTRUST-1) is a pilot global survey to explore the knowledge and perceptions of oncologists regarding COI. We designed an online 27-question-based survey in the English language to explore the perceptions and knowledge of oncologists regarding COI, with an emphasis on LMICs. Descriptive statistics and the Consensus-Based Checklist for Reporting of Survey Studies guidelines were used to report the findings. ONCOTRUST-1 surveyed 200 oncologists, 70.9% of them practicing in LMICs. Median age of the respondents was 36 (range, 26-84) years; 47.5% of them were women. Of the respondents, 40.5% reported weekly visits by pharmaceutical representatives to their institutions. Regarding oncologists' perceptions of COI that require disclosure, direct financial benefits, such as honoraria, ranked highest (58.5%), followed by gifts from pharmaceutical representatives (50%) and travel grants for attending conferences (44.5%). By contrast, personal or institutional research funding, sample drugs, consulting or advisory board, expert testimony, and food and beverage funded by pharmaceutical industry were less frequently considered as COI. Moreover, only 24% of surveyed oncologists could correctly categorize all situations representing a COI. These findings underscore the importance of clear guidelines, education, and transparency in reporting COI in oncology. This hypothesis-generating pilot survey provided the rationale for ONCOTRUST-2 study, which will compare perceptions of COI among oncologists in LMICs and HICs.

Medical oncologist perceptions and willingness to participate in voluntary assisted dying in South Australia.

This study surveyed South Australian medical oncologists to capture their perceptions, willingness to participate and perceived barriers and motivations to participation in voluntary assisted dying (VAD) activities. Approximately 70% of surveyed medical oncologists reported familiarity with VAD legislation. Less than half of physicians (39.1%) reported willingness to participate in any VAD activities, and the rate of conscientious objection was 22%. The top barriers to participation were lack of time and uncertainty given no prior experience. These results demonstrate both a low rate of conscientious objection and a low rate of willingness to participate at the point of VAD implementation in South Australia, and identify barriers to participation that are largely logistical.

Unrealistic expectations and disclosure of incurability in patients with non-small cell lung cancer.

Determining whether patients' unrealistic expectations of chemotherapy as a cure were associated with their perception of the disclosure of incurability. This prospective study included consecutive patients with pretreated non-small cell lung cancer from four study sites. Patients and their oncologists were asked whether they perceived the disclosure of cancer incurability. Patients were also asked if they thought that chemotherapy was curative. We followed up on whether the deceased patients received specialized palliative care 14 months after their last enrollment. Multiple regression analyses were conducted to examine the association between the expectation of chemotherapy as a cure and patient/oncologist-reported perceptions of the disclosure of incurability. We analyzed 200 patients, 77 (38.5%) of whom had unrealistic expectations of a cure. Based on patients' perceptions, incurability was disclosed to 138 (69.0%) patients, and based on their oncologists' perceptions, incurability was disclosed to 185 (92.5%) patients (patient/oncologist agreements, κ = 0.19). Patients without a perception of the oncologist's disclosure of incurability-regardless of their oncologist's perception-were more likely to have unrealistic expectations of a cure than patients for whom both patient and oncologist perceptions were present. Patients who had unrealistic expectations of chemotherapy as a cure were shown to be significantly less likely to have received specialized palliative care, after adjusting for covariates (adjusted OR, 0.45; 95% CI, 0.23-0.91; p = .027). Oncologists' disclosure of incurability was not fully recognized by patients, and expectations of chemotherapy as a cure were associated with patients' perception of the disclosure of incurability.

Depicting oncologists' perceptions and knowledge of global disparities in conflicts of interest reporting: The ONCOTRUST-1 study.

9002 Background: Conflicts of interest (COI) between oncologists and the pharmaceutical industry might considerably influence how the presentation of the research results is delivered, impacting treatment decisions, and policy-making.While there are regulations on reporting COI in high-income countries (HICs), little is known about their reporting in low- and middle-income countries (LMICs).ONCOlogy TRansparency Under Scrutiny and Tracking (ONCOTRUST-1) is a pilot global survey to explore the knowledge and perceptions of oncologists regarding COI. Methods: We designed an online 27-question-based survey in English language to explore the perceptions and knowledge of oncologists regarding COI, with an emphasis on LMICs.Illustrative examples of COI were proposed, based on definitions from the American Society of Clinical Oncology (ASCO) and published literature. Descriptive statistics and the CROSS guidelines were used to report the findings. Results: ONCOTRUST-1 surveyed 200 oncologists, 70.9% of them practicing in LMICs. Median age of the respondents was 36 (range: 26-84) years; 47.5% of them were women. The median number of years of clinical practice was 9 (range: 1-51). 40.5% of respondents reported weekly visits by pharmaceutical representatives to their institutions. Regarding oncologists’ perceptions of COI that require disclosure, direct financial benefits, such as honoraria ranked highest (58.5%), followed by gifts from pharmaceutical representatives (50%) and support for attending conferences (44.5%). In contrast, personal or institutional research funding, sample drugs, consulting or advisory board, expert testimony, and food and beverage funded by pharmaceutical industry were less frequently considered as COI. Moreover, only 24% of surveyed oncologists could correctly categorize all situations representing a COI. Regarding support received from industry, 51.5% of respondents acknowledged trips to conferences as the most common form of support, followed by sample drugs (20.5%). Despite recognizing these interactions, 15% of respondents admitted feeling pressured to prescribe specific drugs due to their COI. Regarding COI reporting, a notable portion of participants indicated they report COI in their presentations (59%) or when publishing their research (30%). The presence of local regulations to manage COI were reported by 35.5% of respondents. The majority advocated for clearer policies and regulations (65%), training and education (63.5%), and an open COI database (55%) to improve COI reporting in oncology. Conclusions: These findings underscore the importance of clear guidelines, education, and transparency in reporting COI in oncology. This hypothesis-generating pilot survey provided the rationale for ONCOTRUST-2 study which will compare perceptions of COI among oncologists in LMICs and HICs.

Perceptions of oncologists and primary care providers on joint care of patients with cancer and chronic medical conditions

Perceptions of oncologists and primary care providers on joint care of patients with cancer and chronic medical conditions

Supporting the support person: Oncologists' roles in reducing support people's uncertainty and facilitating psychological adjustment.

Support people of cancer patients are at significant risk for psychological distress. Additionally, cancer patients' well-being is reciprocally associated with support peoples' psychological well-being. Informed by Uncertainty in Illness Theory, this study tests whether support person psychological well-being is influenced by provider communication and uncertainty reduction. We tested a multiple mediation model to investigate how empathic communication facilitates psychological adjustment in support people of cancer patients and how this process is mediated by support peoples' illness uncertainty and caregiver burden. Support people of cancer patients (N=121; including spouses, adult children, etc.) completed an online questionnaire about their perceptions of oncologists' empathy, uncertainty about the cancer patients' illness, perceived caregiving burden, and their psychological adjustment to diagnoses. Path analysis revealed that (1) more perceived oncologist empathy was associated with less illness uncertainty, (2) more illness uncertainty was associated with worse psychological adjustment and more perceived caregiver burden, and (3) more burden was associated with worse adjustment (χ2 (2)=1.19, p=0.55; RMSEA < 0.01; CFI=1.00; SRMR=0.02). Given the reciprocal nature of well-being between cancer patients and their support people, it is critical to understand and bolster support people's psychological well-being. Results demonstrated how empathic provider communication can support psychological well-being for support people of cancer patients. Additionally, this study offers theoretical contributions to understandings of illness uncertainty in caregiver populations.

Oncologist Perceptions of Racial Disparity, Racial Anxiety, and Unconscious Bias in Clinical Interactions, Treatment, and Outcomes.

Cancer spares no demographic or socioeconomic group; it is indeed the great equalizer. But its distribution is not equal; when structural discrimination concentrates poverty and race, zip code surpasses genetic code in predicting outcomes. Compared with White patients in the United States, Black patients are less likely to receive appropriate treatment and referral to clinical trials, genetic testing, or palliative care/hospice. In 2021, we administered a survey to 369 oncologists measuring differences in perceptions surrounding racial disparity, racial anxiety, and unconscious bias and adverse influence on clinical interactions, treatment, and outcomes for non-White patients. We analyzed responses by generational age group, sex/gender, race/ethnicity, US region, and selection of "decline to respond." The most significant differences occurred by age group followed by race/ethnicity. Racial disparity was perceived as moderate to very high by 84% of millennial, 69% of Generation X, and 57% of baby boomer oncologists, who were also 86% more likely than millennials and 63% more likely than Generation Xers to perceive low/nonexistent levels of racial anxiety/unconscious bias. Most oncologists rarely or never perceived racial anxiety/unconscious bias as adversely influencing clinical treatment or survival outcomes in non-White patients, and White oncologists were 85% more likely than non-White oncologists to perceive rare/nonexistent influence on referral of non-White patients to palliative care/hospice. The discrepancy between 62% of oncologists perceiving moderate to very high levels of racial anxiety/unconscious bias and 37% associating them with adverse influence on non-White patients shows a disconnect, especially among older oncologists (baby boomers), who were also least likely to select the decline option. Together, these factors hinder effective patient-provider communication and result in differential care and outcomes. Oncologists should uncover their own perceptions surrounding racial disparity, racial anxiety, and unconscious bias and modify their behaviors accordingly. It is this simple-and this complicated. Cancer does not discriminate, and neither should cancer care.

Unveiling the Biosimilar Paradox of Oncologists' Perceptions and Hesitations in South Korea: A Web-Based Survey Study.

Biosimilars offer a cost-effective alternative to original biopharmaceuticals with comparable efficacy and safety. The perception and familiarity of prescribers toward biosimilars play a critical role in their market penetration. Yet, few studies have explored the perception of oncologists toward biosimilars, much less in Asia. The objective of this study is to understand barriers of adopting biosimilars among oncologists and explore strategies to promote their use in clinical practice settings. A web-based survey was conducted among Korean oncologists from September to October 2022, assessing their perception of biosimilars and prescribing practices. Among the 118 surveyed oncologists, 75.4% (89 out of 118) had previously prescribed biosimilars. When asked about their preference, 48.3% (57 out of 118) of the respondents preferred originators to biosimilars, whereas 16.1% (19 out of 118) favored biosimilars over the originators. The primary reason for preferring the originators was trust in safety and efficacy (94.7%, 54 out of 57). Still, a paradox was noted as 87.0% (47 out of 54) and 85.2% (46 out of 54) of these also acknowledged the comparable efficacy and safety of biosimilars. A relatively small number of the respondents (16.1%, 19 out of 118) did not consider prescribing biosimilars to biologic-naïve patients at all, and up to 56.8% (67 out of 118) expressed reluctance to switch prescriptions from originators to biosimilars. However, 90.7% (107 out of 118) of respondents considered changing their prescription to biosimilars if patients faced financial stress. Concerns regarding the efficacy when switching to biosimilars were expressed by 42.7% (38 out of 89) of oncologists with biosimilar prescribing experience, increasing to 69.0% (20 out of 29) among those without such experience. Korean oncologists perceived biosimilars to be as safe and effective as originators. However, there is a notable mismatch between this perception and their prescribing practices, particularly among those who have not prescribed biosimilars before. The financial burden of patients served as a significant driver for prescribing biosimilars, yet marginal price differences between originators and biosimilars may be associated with the low adoption rate of biosimilars in Korea. Active price competition may enhance market penetration of biosimilars.

Oncologist perceptions of health inequity.

e18656 Background: The Institute of Medicine has reported on policies and practices based on assumptions and misinformation as pervading the educational, clinical, and payer sectors of health care. In these settings, unconscious bias toward marginalized populations can negatively impact patients, providers, health systems, and research. As national focus on diversity, equity, and inclusion expands, we sought to measure oncologists’ perceptions of issues surrounding health inequity in the context of patient care. Methods: In 2022, we surveyed oncologists’ perceptions of patient diversity, health inequity and disparities, unconscious bias, and their impact. Recruitment was conducted within the Cardinal Health Oncology Provider Extended Network (800 US practices). Participation was voluntary and compensated at fair market value. Results: In total, 192 oncologists responded. Of those surveyed: 48% estimated 10%–25% of their patients were in disadvantaged neighborhoods; 40% estimated 10%–25% were Hispanic or non-White; 69% estimated 10%–50% had low health literacy; and 92% estimated &lt; 10% were of sexual/gender minority. 96% felt prepared to talk with underrepresented patients, 80% agreed that health inequities exist, and 49% agreed they are especially prevalent in oncology. The majority also agreed that health inequities cause differences in care, outcomes, and access to care (80%, 82%, and 70%, respectively). 43% thought unconscious bias adversely affects Hispanic/non-White patients, and 74% perceived health care disparities among these patients. Additionally, 73% thought they would benefit from more research/education, and 50% had educated their coworkers on these issues and provided patient resources. Conclusions: Most oncologists are aware of health inequities and their adverse impact on clinical outcomes; they desire more education and want to help underrepresented patients. Health inequity and disparity may be driven subliminally by lower-quality patient-provider communication (eg, decreased conversationality and less participatory decision-making). Efforts at filling this need in oncology should be prioritized. [Table: see text]

Challenges and knowledge gaps with immune checkpoint inhibitors monotherapy in the management of patients with non-small-cell lung cancer: a survey of oncologist perceptions

Immune checkpoint-inhibitors (ICIs) are changing outcomes in different cancer settings, notably for patients with non-small-cell lung cancer (NSCLC). There are, however, still important gaps of evidence for clinical practice when using these novel treatments. In this study, we assessed physicians' opinion and experience on challenges for clinical practice with ICIs monotherapy in NSCLC. A survey was conducted on experienced physicians treating patients with NSCLC with ICIs. Two rounds of pilot tests were carried out for validation among a group of experts. Topics under analysis were in relation to treatment of elderly populations, performance status, brain metastases, use of steroids or antibiotics, the effects of gut microbiome, autoimmune diseases, human immunodeficiency virus infection, solid organ transplants, use of anti-programmed cell death protein 1 versus anti-programmed death-ligand 1 drugs, atypical tumour responses, predictors of response, duration of treatment and a final open question on additional relevant challenges. Two hundred and twenty-one answers were collected, including 106 (48%) valid answers from experts for final analysis (physicians who have treated at least 20 patients with NSCLC with ICIs). The vast majority agreed that the selected topics in this study are important challenges ahead and more evidence is needed. Moreover, predictors of response, treating brain metastasis, shorter duration of treatment, the effects of gut microbiome and concomitant use of steroids were voted the most important topics to be further addressed in prospective clinical research. This survey contributed to understanding which are the main challenges for clinical practice with ICIs monotherapy in NSCLC. It can also contribute to guide further clinical research, considering the opinions and experience of those who regularly treat NSCLC patients with ICIs.

Patient, Caregiver, and Oncologist Experiences With and Perceptions of Racial Bias and Discrimination in Cancer Care Delivery.

Cancer prevention and treatment systems are significantly impacted by interpersonal, organizational, and structural and systemic racism. A wide body of research has found that racial disparities in access to guideline-adherent cancer care are pervasive throughout the United States and contributing factors include social determinants of health, insurance status, and bias and discrimination in care delivery. Although the existence of racial disparities in cancer care and outcomes is well established, there has been limited research exploring the patient and caregiver experience with bias and discrimination in cancer care. Two national surveys were conducted, one of patients and caregivers and one of oncologists. The surveys examined patient and caregiver experiences with and oncologist perceptions of racial disparities in cancer care. The surveys found that when patients and caregivers were asked about negative care experiences, differences across race were observed. Patients and caregivers identifying as African American/Black (AA/B) or Hispanic/Latino (H/L) were more likely to report at least one negative care experience than patients and caregivers identifying as White (W). Patients who were AA/B or H/L were also more likely than W patients to report that the healthcare system treats people unfairly based on their racial or ethnic background and that racial bias occurs often or very often when a patient and doctor are of different racial/ethnic background. A slight majority of oncologists reported that the healthcare system treats people unfairly based on their racial or ethnic background. The survey results highlight a need for improved racial representation in the oncology professional workforce, improved implicit bias training, and improved clinical trial recruitment efforts.

Patients’ and oncologists’ perceptions towards the discussion on high-cost innovative cancer therapies: findings from a qualitative study

ObjectivesIn the last decades, innovative technologies for cancer treatment were developed rapidly. In most cases, their price is high, with no funding offered by public health systems. The present study...

Characterizing experiences of non-medical switching to trastuzumab biosimilars using data from internet-based surveys with US-based oncologists and breast cancer patients

PurposeTo characterize current experiences with communication and decision-making practices when non-medical switching to a biosimilar trastuzumab is proposed or required by cancer center or insurer.MethodsWe developed and launched 60- and 51-item internet surveys to elicit US breast cancer patient and medical oncologist lived experiences with trastuzumab biosimilars and patient information needs and seeking practices. We recruited participants using social media and administered via REDCap in 2020–2021.Results143 breast cancer patients and 33 medical oncologists completed the surveys. 63.9% patients reported having switched to a trastuzumab biosimilar and 40.8% reported receiving no prior notification about switching. 44% of patients reported learning about biosimilars primarily through self-directed learning and 41% wanting more time to discuss with oncologist. None of the oncologists reported that the decision to switch a patient to a biosimilar was initiated by them, but rather more frequently by the insurer (45.2%). About 54.8% reported not receiving any pharmaceutical manufacturer material related to the selected biosimilar. Patients and oncologists diverged in their responses to items regarding patient opportunities to ask questions, adequacy of resources, effectiveness of treatment, patient worry, and magnitude of change.ConclusionThere is a need for tailored and effective patient and oncologist information and education on trastuzumab biosimilars, along with improved healthcare communication regarding switching. The discrepancy between patient-reported experiences and oncologist perceptions of the patient experience, suggests a lack of adequate information that may be a challenge not only to the uptake of trastuzumab biosimilars, but to the patient-oncologist relationship.

Abstract P2-13-13: The patient-centered paradox: A US-based survey of physician- and patient-reported experiences with biosimilar trastuzumab

Abstract Background Biologics, such as trastuzumab (Herceptin) for HER2+ breast cancer, have been revolutionary in improving survival for early stage and metastatic disease. However, their high cost increases cancer care expenses. Recent approval of trastuzumab biosimilars is promising in terms of cost savings and health benefits of access to life-saving treatment for more patients. Although clinical trials have demonstrated equivalence in efficacy and safety between biosimilars and the reference drug, multiple barriers to uptake have been identified. Ours is the first survey comparing the experiences and perspectives of oncologists and patients. Methods We developed a 60-item survey to characterize the experiences of US patients (with HER2+ breast cancer) and oncologists with trastuzumab biosimilar(s). Survey invitations were distributed via social media and data were collected using REDCap. Results From August 2020 to June 2021, 33 physicians and 143 patients (1 male) completed the survey. Average age was 49.72 years (SD = 10.95) for patients and 46.16 years (SD = 11.04) for oncologists. Respondents were (patients and oncologists, respectively) White (71%, 39%), Black (2%, 1%); and not Hispanic (71%, 82%). Over half of the patients (56%) reported having a bachelor’s degree and above and private insurance (58%). Half (55%) reported metastatic breast cancer; 85% having received treatment within the past year. About 56% reported being presented with an option to switch from biologic trastuzumab to biosimilar and 63% reported having switched. Of those who reported a switch, 40% received no prior notification. Using a scale of 0 (Disagree)-100 (Agree), we administered 13 matching questions to oncologists and patients about their experience (and perspective) with trastuzumab biosimilars. Patients reported lower ratings than oncologists, t(160) = 3.74, p = .006 (patients: M = 43.74, SD = 18.94; oncologists: M = 56.66, SD = 11.50). Smaller proportion of patients than oncologists responded positively (a score of &amp;gt;50) to all but 1 item (Table). About 44% of patients reported learning more about biosimilars through self-directed learning and 41% reported wanting more time to discuss with oncologist, achieving a better understanding of biosimilars (39%) and having access to printed materials (30%) and specifically, ones that are user-friendly (18%). Conclusions These findings highlight a discrepancy between patient-reported experiences and oncologist perceptions of the patient experience. Our findings suggest that lack of adequate information is a challenge not only to the uptake of trastuzumab biosimilars, but to the patient-oncologist relationship. There is a need for effective and tailored education for both oncologists and patients to facilitate communication regarding trastuzumab biosimilars, and to assure patients of safety and efficacy. % respondents with scores of &amp;gt; 50 (0 (Disagree) - 100 (Agree))Patients (n = 143)Oncologists (n = 33)My oncologist explained a switch to biosimilar trastuzumab in a way that was easy to understand42%58%I feel/felt involved in this treatment decision to choose a biosimilar trastuzumab for me17%18%I trust my oncologist in making the right decision to choose a biosimilar trastuzumab for me63%67%I trust my insurance company in making the right decision to require biosimilar trastuzumab instead of Herceptin9%12%I trust my hospital/center in making the right decision to require biosimilar trastuzumab instead of Herceptin41%44%I was given the opportunity to ask questions about a switch to biosimilar trastuzumab35%59%I was given adequate resources on biosimilar trastuzumab to feel comfortable with a switch18%33%My cancer is/will be treated as effectively with biosimilar trastuzumab as with Herceptin43%79%I understand the reason for switching to biosimilar trastuzumab43%39%This treatment switch to biosimilar trastuzumab DOES NOT make me worried24%41%I have emotionally adjusted to this treatment switch that wasnt due to cancer progression or quality of life issues41%42%I DO NOT worry more about my treatment success since this switch to a biosimilar trastuzumab29%33%Switching to a biosimilar trastuzumab is a minor change to my cancer care37%67%Note: Presented are patient-framed questions. Oncologist questions were reframed accordingly. Citation Format: Elizabeth Lerner Papautsky, Martha Carlson, Maryam Lustberg. The patient-centered paradox: A US-based survey of physician- and patient-reported experiences with biosimilar trastuzumab [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-13.

Radiation Oncologist Perceptions of Therapeutic Cannabis Use Among Cancer Patients

<h3>Purpose/Objective(s)</h3> Cancer patients are increasingly incorporating medical marijuana into the management of treatment-related side effects. Currently however, data is limited regarding the risks and benefits of therapeutic cannabis for cancer patients. We sought to characterize radiation oncologists' practices and opinions regarding therapeutic cannabis via a nationwide survey. <h3>Materials/Methods</h3> An anonymous survey was distributed via email to 873 radiation oncologists in the American Society for Radiation Oncology member database. Radiation oncologists were asked their opinions and practices regarding the use of therapeutic cannabis for their patients. Bivariate analyses of potential predictors for responses were conducted using standard statistical techniques. <h3>Results</h3> 107 radiation oncologists completed the survey. Thirty-nine percent of physicians reported having completed paperwork for medical marijuana in the past year. Seventy-one percent of respondents reported therapeutic cannabis as being effective for managing treatment-related toxicities, however only 36% reported that they would recommend it to their patients. Practicing in a state where medical marijuana is legal, and practicing for less than 5 years, were associated with being more likely to recommend therapeutic cannabis (OR = 3.79, <i>P</i> = 0.01 and OR = 2.68, <i>P</i> = 0.04, respectively). Physicians working in private practice were more likely to report a benefit of therapeutic cannabis for treatment-related toxicities than academic physicians (OR = 2.82, <i>P</i> = 0.02). Eighty-one percent of radiation oncologists reported that therapeutic cannabis is beneficial for patients receiving end-of-life care. Fifty-eight percent of physicians reported lacking sufficient knowledge to advise patients regarding therapeutic cannabis, and 86% of respondents were interested in learning more about therapeutic cannabis for cancer patients. <h3>Conclusion</h3> Although a majority of radiation oncologists believe there are benefits to therapeutic cannabis, many are hesitant to recommend for or against its use. Most radiation oncologists agree that therapeutic cannabis should play a role in supportive care for patients receiving end-of-life care. Radiation oncologists appear to be interested in learning more about how therapeutic cannabis may play a role in their patients' care.

Interaction with patients of color or ethnic minority (PCEM): Oncologist perceptions of racial anxiety and/or implicit bias (RA/IB).

141 Background: Oncologists interacting with PCEM may be unaware of RA/IB, yet data show lower-quality care. Helping oncologists recognize this may improve quality of patient-provider interaction, care, and outcomes. We conducted a descriptive study of medical/hematologic oncologists to assess perceptions of RA/IB impact on PCEM interaction. Methods: From February to April 2021, U.S.-based medical/hematologic oncologists participated in an online survey of perceptions on cancer care and outcomes in PCEM (part of broader survey of various clinical and practice-related concerns). Questions used a modified 5-point Likert scale with an option of declining to answer, and respondents were aware data would be anonymized and aggregated. Results: Among 369 physicians surveyed, median years in practice were 17 (range 2-49). Most (72.4%) were in community settings; 64.0% were age 40 to 59 years; 20.6% identified as female, 70.5% male, and 8.7% declined to disclose. Racial distribution was 32.0% White, 33.1% Asian, 7.0% Black, 4.1% Hispanic/Latinx, and 18.7% declined to disclose. When asked the degree of RA/IB White providers had toward PCEM, 39.6% chose low/none, 33.3% moderate, 14.9% high/very high, and 12.2% declined. When asked whether RA/IB among White providers adversely affects PCEM, 37.1% somewhat/strongly agreed, 29.3% somewhat/strongly disagreed, 23.6% neither agreed nor disagreed, and 10.0% declined. Also, 7.9% declined to estimate percent of non-White patients managed. Perceived frequency of scenarios involving RA/IB impacting PCEM interaction at their practices was also assessed (Table). Notably, 12.0% to 14.0% declined to answer regarding their own practices. Although most oncologists (76.4%) perceived RA/IB among White providers toward PCEM, only 37.1% agreed it had adverse effects. Conclusions: Discrepancy in perception of RA/IB among White providers and its effect on PCEM suggests a need to show causality, and declining to respond suggests mistrust/apprehension in expressing true views. Findings suggest oncologists may benefit from improved education and awareness regarding RA/IB in PCEM interaction, treatment, and outcomes. Provider responses (N=369).[Table: see text]

Cancer treatment and outcomes in patients of color or ethnic minority (PCEM): Oncologist perceptions of racial anxiety and/or implicit bias (RA/IB).

104 Background: Healthcare disparities are prevalent in cancer, with patients of color or ethnic minority (PCEM) at greatest risk for poor outcomes due to limited access to care, low health literacy and socioeconomic status, and potentially, racial anxiety and/or implicit bias (RA/IB) among oncologists. We conducted a descriptive study of medical/hematologic oncologists to assess perceptions of impact of RA/IB on treatment decisions and outcomes in PCEM. Methods: From February to April 2021, U.S.-based medical/hematologic oncologists participated in an online survey of perceptions regarding cancer care and outcomes in PCEM as part of a broader survey of various clinical and practice-related concerns. Questions used a modified 5-point Likert scale with an option of declining to answer, and respondents were aware that data would be anonymized and aggregated. Results: Among the 369 physicians surveyed, median years in practice were 17 (range 2-49). Most (72%) worked in community oncology; 64% were age 40 to 59 years; 21% identified as female, 70% as male, and 9% declined to disclose gender. Racial distribution was 32% White, 33% Asian, 7% Black, 4% Hispanic/Latinx, and 19% declined to disclose. Regarding perception of the degree of racial/ethnic healthcare disparity experienced by PCEM, 33% chose moderate, 29% very high/high, 29% low/none, and 8% declined to answer. Regarding how often RA/IB adversely affected survival among PCEM at their own practice, a majority (58%) chose rarely or never, 33% very often/almost always, often, or sometimes, and 9% declined to answer. Perceived frequency of specific scenarios involving RA/IB as adversely influencing treatment decisions at their practice (referral/recommendation for oncologic standard-of-care [SOC] modalities/services) was also assessed. The combinations of very often/almost always, often, and sometimes responses were: clinical trial referral (35%); palliative/hospice care (31%); novel therapeutic regimen vs. SOC selection (e.g., chemo/targeted/radiation therapy) (28%); surgical treatment recommendation (26%); and genetic/genomic testing referral (24%). Notably, 10% to 12% declined to answer. Conclusions: A majority of the medical/hematologic oncologists surveyed recognized the role of RA/IB in substandard treatment and outcomes among PCEM, but were less likely to perceive it within their own practice, suggesting a need for better identification. Notably, 24% to 35% recognized its adverse influence on SOC treatment decisions for PCEM. Further, 19% declined to identify their own race/ethnicity and 10% consistently declined to answer all treatment decision-making questions related to disparity, suggesting mistrust or apprehension in expressing true views. Findings suggest that oncologists may benefit from improved education regarding RA/IB and healthcare disparities in PCEM.

PCN189 Application of Augmented Intelligence (AI) in Oncology: A Physician Perspective

Integration of AI (defined as a technology solution that uses machine-based algorithms to learn from experience, adjust to new inputs, and augment the capabilities of humans) into cancer care has the potential to drive efficiencies and reduce costs of care by helping target resources and efforts. The objective of this study was to assess the perceptions of oncologists regarding the utility and application of AI in cancer care.

Patterns of knowledge and use of medical cannabis among Brazilian oncologists and palliative care physicians.

e24099 Background: Medical cannabis (MC) emerged as an important complementary therapy in the context of oncological diseases. In 2019, the Brazilian Health Regulatory Agency (Anvisa) approved use of MC, which can be produced in the country and sold in pharmacies under medical prescription. Previous investigations have extensively correlated MC effectiveness, over management and support of symptoms caused by the disease and/ or its treatment. However, studies evaluating knowledge and patterns of MC use in oncology patients MC are lacking. In the present study, we assessed the perception of oncologists and palliative care physicians on MC as a complementary therapy for cancer patients, and their personal experiences in clinical practice in Brazil. Methods: In October 2020 an online survey was sent via e-mail by the Brazilian Society of Clinical Oncology and the National Academy of Palliative Care for physicians with expertise in oncology and/or palliative care. Outcomes measured included knowledge and opinions about MC, prescription experience and impressions about the Brazilian legislation. Data analysis was performed with descriptive statistics, comparison tests and the Poisson regression model with robust variance, using the IBM Statistical Package for the Social Sciences software, version 25. Results: A total of 124 physician participated in the study and, of those, 58.1% were oncologists, and 82.3% believed that MC has application as a complementary therapy in cancer. In contrast, only 52.4% of the participants felt comfortable recommending its use and only 15.3% have ever prescribed MC for their patients with cancer. Further, among those who have never prescribed, 71% have already referred patients to other professionals to prescribe, and 61% indicated lack of knowledge as the main factor for not prescribing. In addition, more than half of participants claimed not knowing Brazilian legislation regarding MC use. Nausea and vomiting were mentioned by 73.4% of physicians as the major indication for MC. Conclusions: Oncologists and palliative care physicians agree with the applicability of MC use for the management of symptoms related with or caused by cancer. However, our findings infer that factors such as lack of knowledge, legislation barriers and lack of robust scientific evidence, lead to its limited use among Brazilian oncologists and palliative care physicians.

Radiation oncologist perceptions of therapeutic cannabis use among cancer patients.

Cancer patients are increasingly incorporating medical marijuana into the management of treatment-related side effects. Currently however, data is limited regarding the risks and benefits of therapeutic cannabis for cancer patients. We sought to characterize radiation oncologists' practices and opinions regarding therapeutic cannabis via a nationwide survey. An anonymous survey was distributed via email to 873 radiation oncologists in the American Society for Radiation Oncology member database. Radiation oncologists were asked their opinions and practices regarding the use of therapeutic cannabis for their patients. Bivariate analyses of potential predictors for responses were conducted using standard statistical techniques. One hundred seven radiation oncologists completed the survey. According to the survey, 36% of respondents would recommend therapeutic cannabis to their patients to mitigate treatment toxicity. Physicians practicing in states where medical marijuana is legal were more likely to recommend it compared to physicians working in states that have not legalized medical marijuana (OR = 3.79, 1.19-12.1, p = 0.01). Seventy-one percent of respondents reported therapeutic cannabis as being effective at least some of the time for managing treatment-related toxicities. Fifty-eight percent of physicians reported lacking sufficient knowledge to advise patients regarding therapeutic cannabis, while 86% of respondents were interested in learning more about therapeutic cannabis for cancer patients. Although a majority of radiation oncologists believe there are benefits to therapeutic cannabis, many are hesitant to recommend for or against its use. Radiation oncologists appear to be interested in learning more about how therapeutic cannabis may play a role in their patients' care.