Practices Of Medical Oncologists Research Articles

Oncologists' attitudes towards prophylaxis of cancer associated venous thromboembolism: A prospective, descriptive study.

Cancer-associated venous thromboembolism creates a big burden on both patients and healthcare systems. Clinical guidelines have a consensus on the initiation of prophylactic treatment for hospitalised patients, however a debate still exists for ambulatory cancer patients. Therefore, this study aimed to identify attitudes and practices of medical oncologists on cancer-associated venous thromboembolism management. An online survey consisting of 22 questions was developed by researchers in the view of previous studies and delivered to 100 medical oncologists registered to the national society of medical oncology by e-mail between September and October 2018. Descriptive and statistical analyses were performed using Statistical Package for Social Science (SPSS) version 23.0 (ICM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). A total of 62 medical oncologists (75.8% male) responded to the survey (response rate of 62%). The most critical three risk factors considered for initiating prophylaxis were prior venous thromboembolism history, immobilisation and tumour/cancer type for inpatients and outpatients (χ2 test, p < 0.001). The first choice of drug for prophylaxis was mostly low molecular weight heparins (n = 60, 96.8%). In the absence of contraindications, physicians initiate prophylaxis 'usually' for inpatients (n = 25, 40.3%) and outpatients (n = 5, 8.1%). However routine use of the Khorana score is not incorporated into the risk assessment process of cancer patients. Attitudes of oncologists towards thromboprophylaxis in cancer patients are consistent with previous studies in the literature. The respondents are aware of the venous thromboembolism risk of cancer patients, however raising awareness on both cancer-associated venous thromboembolism and current guideline recommendations is needed.

Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada.

Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets. A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets. Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low-added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment. The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.

Should CNS IPI Change the Practice of Medical Oncologists in Treatment of Diffuse Large B Cell Lymphoma? A Single Center Experience

Should CNS IPI Change the Practice of Medical Oncologists in Treatment of Diffuse Large B Cell Lymphoma? A Single Center Experience

Knowledge and practices of medical oncologists concerning nutrition therapy: A survey study

Despite the identification of malnutrition and administration of nutrition therapy being increasingly recognised as integral to the treatment of cancer patients, this is not always translated into routine clinical practice. The aim of this study was to determine medical oncologists' awareness of, and ability to assess, nutritional status and when to initiate nutrition therapy, to identify their educational status concerning clinical nutrition and their perceived barriers to the routine use of nutrition therapy in their patients through a survey study. 155 medical oncologists were invited to complete a digital questionnaire. The questionnaire included information regarding the participants demographic and professional information, clinical nutrition education status, attitudes towards malnutrition and nutrition therapy, and barriers to using nutrition therapy. The questionnaire also included two case scenarios designed to assess ability to diagnose malnutrition/assess nutritional status and identify when nutrition therapy might be indicated. Of 109 medical oncologists who agreed to participate, 43.1% declared that they received clinical nutrition education and 33.9% declared that they followed the oncology sections in the European Society of Clinical Nutrition and Metabolism (ESPEN) Guidelines. The medical oncologists were divided into two groups according to their knowledge score (31 medical oncologists with a knowledge score of <3 and 78 medical oncologists with a knowledge score of ≥3). The rate of having nutrition education was significantly higher in those with a higher knowledge score (≥3) and the rate of medical oncologists having this education during medical and/or oncology education was also significantly higher. The rate of medical oncologists following the oncology sections in the ESPEN guidelines was higher in those with higher knowledge score. Our results emphasize the association between clinical nutrition education and higher knowledge scores in medical oncologists, but reveal a mis-match between knowledge and awareness and what happens in clinical practice. Nutrition therapy might be used more frequently in routine practice when medical oncologists' lack of knowledge is resolved.

A survey of perceptions, attitudes, knowledge and practices of medical oncologists about cancer pain management in Spain.

To monitor oncologists' perspective on cancer pain management. An anonymized survey was conducted in two waves. First, over a convenience sample of oncologists known to be particularly concerned with the management of pain. Second, using a random sample of oncologists. In total, 73 and 82 oncologists participated in the first and second wave, respectively. Many oncologists reported to have good knowledge of analgesic drugs (95.9%), the mechanism of action of opioids (79.5%), and good skills to manage opioid-related bowel dysfunction (76.7%). Appropriate adjustment of background medication to manage breakthrough pain was reported by 95.5% of oncologists. Additionally, 87.7% (68.3% in the second wave, p=0.035) of oncologists reported suitable opioid titration practices, and 90.4% reported to use co-adjuvant medications for neuropathic pain confidently. On the other hand, just 9.6% of oncologists participated in multidisciplinary pain management teams, and merely 30.3 and 27.1% reported to routinely collaborate with the Pain Clinics or involve other staff, respectively. Only 26.4% of the oncologists of the second wave gave priority to pain pathophysiology to decide therapies, and up to 75.6% reported difficulties in treating neuropathic pain. Significantly less oncologists of the second wave (82.9 vs. 94.5%, p=0.001) used opioid rotation routinely. Unlike in previous surveys, medical oncologists reported in general good knowledge and few perceived limitations and barriers for pain management. However, multi-disciplinary management and collaboration with other specialists are still uncommon. Oncologists' commitment to optimize pain management seems important to improve and maintain good practices.

Utilization of advanced molecular analyses in lung cancer: A country perspective—Young Research Group.

e18027 Background: Molecular and genetic analyses in cancer treatment are continuously evolving, and taking part in patient management. This study evaluated the clinical practices of medical oncologists in Turkey for utilization of these methods in lung cancer patients. Methods: All medical oncologists registered to Turkish M.Oncology Society were called to participate an online survey about their practice patterns of using molecular and genetic analyses for the management of lung cancer patients. Survey included 19 questions for demographic data, work environment, knowledge about the molecular and genetic analyses, and barriers to use these methods. Results: A total of 188 medical oncologists (M/F: 117/71; mean age 39.3±6.7) were participated. The key findings: Work environment: Academia 49%; others 51% Checking mutations in adenocancer: 88.4% Molecular analyses available at home institution: 61.4% Checking EGFR, EML-ALK, ROS-1 in NSCLC: 75.7% Non-specifically checking markers: 58.2% Checking markers only for locally advanced/metastatic disease at diagnose: 75.1% Obtaining analyze results in: 8-14 days 45%; 15-21 days 31.2% Obtaining a positive EGFR/ALK report after initiating chemo: re-evaluate patient after 2/3 cycles 68.3%; stop chemo and shift to targeted therapy 20.6%; continue full-regimen 12.2% Maintenance therapy after response regardless of mutation: 36% If targeted therapy initiated regardless of mutation, the preferred 1st step cytotoxic chemo regimen in metastatic adenocancer: cisplatin+pemetrexed 50.2% Analyzing mutation from primary lung biopsy: 95.8% Re-biopsy if sample was inadequate: 91.5% Secondary biopsy for: EGFR/ALK discordance 38.1%; progression under treatment 46%; young patient 22.2%; never-smoker 34.9%; test-negative but presumed to be clinically-positive patient 46.6% Conclusions: Majority of the medical oncologists in Turkey use molecular and genetic analyses in clinical practice. But, the limited availability and the lags in obtaining results lead oncologists to initiate treatment primarily based on clinical findings. Once these methods become more available, targeted therapies and consequent favorable outcomes will increase in oncology practice.

Referral practices of medical oncologists to palliative care for patients with metastatic non-small cell lung cancer (NSCLC).

108 Background: Early implementation of palliative care has shown to improve quality of life and prolong survival in pts with metastatic NSCLC. We sought to investigate the attitudes and referral practices among medical oncologists treating pts with metastatic NSCLC. Methods: Participants were identified through the IASLC 2015 membership directory. All participants were contacted via email to complete an 18-question online survey that included demographic variables as well as questions on referral practice and attitudes regarding the role of palliative care in the treatment of metastatic NSCLC pts. Results: The response rate was 31% (93/303). The majority of participants (94%) practice in an academic setting and 57% had no prior palliative care training. 88% of oncologists report easy access to palliative care providers and 94% have an affiliated palliative care practice within their institution. 83% believe there is definitive evidence in the literature supporting the benefit of early palliative care; however, 40% feel this evidence supports only improved quality of life, not prolonged survival. 58% of oncologists agree that metastatic NSCLC pts should be referred to palliative care early in their disease course. In practice, however, they refer 19% of pts to palliative care at the time of first treatment initiation and this only increases to 38% when considering all referrals made when pts are actively receiving chemotherapy. Reasons for not referring pts include lack of symptoms (56%), belief that oncologists can manage palliative care needs independently (46%), not wanting to burden pts with appointments (41%), concern that referral may not be well received by pts (38%), and long wait times (20%). Reasons for referral include inadequately managed pain (97%), no further treatment options (70%), weak support network (71%), depression/anxiety (68%), other cancer-related symptoms (69%), dwindling treatment options (66%), and lack of time to address palliative care needs (58%). Conclusions: While most oncologists acknowledge the benefit of early palliative care consultation for metastatic NSCLC pts, a minority of pts are referred and strategies to improve referrals are needed.

Interleukin 2 for patients with renal cancer

Interleukin 2 (IL-2) is the only systemic treatment currently available that is capable of curing patients with metastatic renal cell cancer (RCC). The first indications that IL-2 could mediate objective responses in patients with metastatic RCC were reported in 1985. On the basis of the durability of the complete responses in multiple trials, the FDA approved high-dose IL-2 for the treatment of patients with metastatic RCC in 1992. In the Surgery Branch of the National Cancer Institute, a 20% objective response rate (9% complete and 11% partial) was seen in 259 consecutive patients with metastatic RCC treated with high-dose IL-2 alone, with only 2 treatment-related deaths. Among the 23 patients showing a complete response, disease recurrence has occurred in only 4 patients; the remaining 19 patients all have ongoing responses of between 2 and 18 years. These results indicate that over 80% of all patients who obtain a complete response following high-dose IL-2 never experience disease recurrence and seem to be cured of their disease. In the August 2007 issue of this journal, two Practice Point articles reviewed the recently published studies that evaluate the multikinase inhibitors sorafenib and sunitinib for the treatment of patients with metastatic RCC. Treatment with these agents resulted in the prolongation of disease-free survival, and on this basis sorafenib and sunitinib were approved by the FDA. There were no complete responses in the 335 patients who received sunitinib and one complete response in the 451 patients who received sorafenib. In the commentary on the sorafenib paper, Twardowski and Figlin appropriately concluded that sorafenib is “primarily indicated as a second-line treatment for patients…who develop progressive disease after cytokine therapy”. In the commentary of the paper on sunitinib, however, Stadler and Szmulewitz concluded that sunitinib is a “reasonable first-line agent, especially in patients with good or intermediate prognosis, and is a standard of care”. They base this statement on the comment that IL-2 is “toxic and not feasible for most patients”. Stadler and Szmulewitz, therefore, advocate the use of sunitinib, despite the fact that this agent cures virtually no one, whereas high-dose IL-2 apparently cures about 8% of patients. High-dose IL-2 has been considerably underused in the treatment of patients with metastatic RCC, because it is inconvenient to administer and results in types of toxicity not common in the practice of medical oncologists. It must be administered as an inpatient procedure at 8-hour intervals and each dose needs to be administered to patient tolerance. The major toxicities of high-dose IL-2 result from a capillary-leak syndrome, which leads to fluid extravasation into tissue, hypotension and oliguria, all of which are reversible with no long-term sequelae. Physicians with experience in the use of high-dose IL-2 can very safely administer this agent to patients with normal cardiac and renal function. Careful monitoring and fluid replacement can solve virtually all of the problems associated with IL-2 administration. Many oncologists, comfortable with severe and prolonged neutropenia and thrombocytopenia, seem unwilling to contend with the physiologic disturbances caused by high-dose IL-2 administration. Decisions about the use of IL-2 seem to be more related to the training of oncologists than to the effectiveness of the treatment. IL-2 should be the first-line treatment for patients with metastatic RCC. Most patients would not refuse to undertake this treatment if they were informed that it was the only chance of eradicating their disease and that the benefits far outweighed the risks. Sorafenib and sunitinib are valuable adjuncts for the treatment of these patients, but should most appropriately be used as second-line agents.

Management of Postmenopausal Symptoms in Breast Cancer Survivors

With the increasing numbers of breast cancers survivors, menopause, its symptoms, and its physical complications are becoming more prevalent problems in this patient population. Hormonal replacement, which has been the cornerstone therapy of menopausal related symptoms for decades, recently has been shown to increase breast cancer incidence as well as risk of recurrence and no longer should be recommended. Menopausal symptoms and complications such as hot flashes, vaginal dryness, dyspareunia, and osteoporosis leading to fractures have a negative impact on the quality of life of both breast cancer survivors and the general postmenopausal population. The purpose of this review is to discuss the evidence for the use of alternative therapies for menopausal symptoms, thus providing guidance and recommendations that should facilitate therapeutic decisions in the daily practice of medical oncologists and primary care physicians.

How Rapidly Do Oncologists Respond to Clinical Trial Data?

In the era of evidence-based medicine, convincing clinical trial data should influence clinical practice if disseminated in an appropriate manner. Here we discuss the influence of clinical trial results from the Arimidex, Tamoxifen Alone or in Combination trial on the usage of tamoxifen and anastrozole in the treatment of postmenopausal women with hormone receptor-positive early breast cancer. Data were derived from structured interviews with practicing medical oncologists over a period of 28 months. The overall use of hormonal therapy was high and increasing over the period studied. Significant increases in the use of anastrozole as adjuvant hormonal therapy were accompanied by significant decreases in the use of tamoxifen. This culminated in the use of anastrozole surpassing tamoxifen use by the end of the study period, accounting for over 50% of hormonal therapy use for postmenopausal early breast cancer. This study suggests that the dissemination of key clinical data, accompanied by professional commentary and regulatory actions, can rapidly influence the clinical practice of medical oncologists.