Reasons For Treatment Choices Research Articles

Real-World Treatment Patterns, Clinical Outcomes, and Symptom Burden in Patients With Psoriatic Arthritis Prescribed Ixekizumab in the United States.

The objective of this study was to describe the real-world characteristics and clinical status of patients with psoriatic arthritis (PsA) currently prescribed ixekizumab. Data were drawn from the Adelphi PsA Plus Disease Specific Programme (DSP), a cross-sectional survey conducted in the United States between September 2021 and March 2022. Rheumatologists provided data for their next five consulting patients currently receiving ixekizumab, including demographic and clinical characteristics, disease severity, treatment history, reasons for treatment choice, satisfaction with current treatment, and current and historic symptom burden. Patients voluntarily completed questionnaires, providing perceptional data on symptom burden and satisfaction with current treatment. Overall, 68 rheumatologists provided data on 275 patients with PsA, 90 of whom completed the voluntary questionnaire. Patients had been prescribed ixekizumab for a mean of 11.7 (SD 10.6) months. Clinical characteristics, disease severity, and symptom burden of patients with PsA improved significantly from ixekizumab initiation to the most recent consultation, including symptom burden, tender and swollen joint counts, and body surface area affected by psoriasis (all P < 0.001). Both rheumatologists and patients were satisfied with ixekizumab treatment and reported improvements in pain and fatigue. Improvements were noted after more than three months of ixekizumab treatment duration and regardless of whether the patients had prior exposure to an advanced therapy or were treatment naïve. Our results indicate that ixekizumab was efficacious in the treatment of PsA in real-world clinical practice, complementing efficacy data from randomized controlled clinical trials. The results of this study may assist rheumatologists and their patients in making informed treatment choices.

Evaluating Treatment Choice in Patients with Moderate to Severe Psoriasis in the United States: Results from a US Patient Survey.

While multiple treatments are available for moderate to severe psoriasis, patient preferences are rarely systematically studied. This study aims to identify factors associated with choice of a new once-daily oral psoriasis treatment, elicit patient views on treatment characteristics, and rank treatment characteristics by importance. This noninterventional, cross-sectional survey study, conducted from December 2021 to June 2022, recruited US adults with moderate to severe psoriasis. Demographics, clinical characteristics, and perspectives on psoriasis treatment were collected. Factors associated with the choice of a new oral treatment were identified using multivariable logistic regression analysis. Treatment characteristics and reasons for treatment choice were ranked using bivariate comparisons. The study included 882 participants [mean (standard deviation; SD) age, 45.7 (12.8) years; female, 67.7%; White, 74.9%]; 92.7% were currently receiving treatment [mean (SD) duration, 2.9 (4.8) years]. Half of participants rated their psoriasis symptoms over the past week as mild, very mild, or nonexistent; 36.5% as moderate; and 12.7% as severe or very severe. Most (66.5%) indicated willingness to start a new oral treatment; 65.0% indicated that the new oral treatment would cause less anxiety than injections/infusions. Participants were significantly more likely to start the new oral treatment if they were currently receiving a tumor necrosis factor inhibitor [odds ratio (OR): 2.1, 95% confidence interval (CI): 1.4-3.1] or ustekinumab (OR: 2.7, 95% CI: 1.6-5.0) versus apremilast (P < 0.001) or if they reported mild (OR: 3.2, 95% CI: 2.0-4.9), moderate (OR: 5.0, 95% CI: 3.1-8.2), or severe (OR: 7.6, 95% CI: 3.9-15.0) psoriasis symptoms compared with those who reported no symptoms in the past week (P < 0.001). Most participants indicated willingness to start a new once-daily oral treatment, viewing it as less anxiety provoking than injections/infusions. Current treatment and psoriasis severity affected participants' willingness to start a new oral treatment.

Real-world physician practices on the diagnosis and management of allergic rhinitis in the Philippine setting.

Physician awareness and adherence to guidelines varies among countries and between types of physician practice. Identifying the needs of the physician and patient is essential to improve patient outcome. Data on physician diagnosis and management of allergic rhinitis (AR) in the Philippines is currently limited. Study objectives are to assess awareness and use of guidelines, practices on diagnosis and management of intermittent and persistent AR, reasons for choice of therapy, and familiarity with immunotherapy. A cross-section of 590 specialist and 223 subspecialist physicians from 17 regions of the Philippines were surveyed from October 2021 to July 2022. Survey consisted of a 12-point validated online questionnaire on knowledge and use of guidelines for diagnosis and treatment, use of diagnostic tests, preferred pharmacologic treatment, preferred adjuvant therapy, reasons for treatment choice, and familiarity with immunotherapy. Seventy-seven percent of respondents used Allergic Rhinitis and its Impact on Asthma guidelines for diagnosis and management of AR. Three-fifths of respondents "always" routinely evaluated AR patients' history and performed a physical examination for asthma; 57% of respondents "always" routinely evaluated asthma patients' history and performed a physical examination for AR. Allergy testing was "sometimes" recommended by 62.2%. Oral second-generation antihistamines were the preferred choice for the treatment of intermittent AR. Intranasal steroids were the preferred treatment for persistent AR. Top reasons for choice of treatment were guideline recommendations, efficacy, onset of action, cost, and availability of treatment. Filipino specialists and subspecialists are aware and use guidelines in diagnosis and management of AR. Clinical history and physical examination are the cornerstone of diagnosis. Management practices for intermittent and persistent AR are similar for both groups. Recognizing the role of patient treatment preferences and allergen-specific immunotherapy remains to be a gap in the management of AR by Filipino physicians.

Reasons for oncologist and urologist treatment choice in metastatic castration-sensitive prostate cancer (mCSPC): A physician survey linked to patient chart reviews in the United States.

5065 Background: Based on level 1 evidence of overall survival, ASCO/NCCN/AUA guidelines uniformly recommend novel hormonal therapy (NHT) or chemotherapy (CHT) added to androgen deprivation therapy (ADT) as standard of care in mCSPC. However, real-world evidence across US healthcare systems suggests most patients receive ADT +/- first generation non-steroidal antiandrogens (NSAA). Reasons behind the lack of treatment intensification (TI) in mCSPC have not been studied. Methods: Data from medical charts of patients initiating mCSPC treatment from Jul ’18-Nov ‘21 were retrospectively extracted from multiple US academic/community practices. Oncologists and urologists who treated these patients were surveyed to provide reasons for treatment choices including prostate specific antigen (PSA) goals and explicit reasons for not prescribing NHT. Descriptive statistics (Fishers exact tests) were used to compare outcomes between groups; p-values for odds ratios (OR) were generated via Wald test. Results: 65 oncologists and 42 urologists provided data on 621 patients. Median age at initial mCSPC treatment start was 68.0 years, 58% were White, 25% Black, 84% had de novo metastases, 30% had high-volume disease including 22% with visceral metastases, and 83% had ECOG PS score ≤1. In the first-line (1L) setting, most mCSPC patients received ADT±NSAA alone (69%), while TI rates with ADT+NHT (26%) or ADT+CHT (4%) were low. An additional 27% (n = 166/621) received subsequent TI while still castration-sensitive. According to the physician survey, the top 5 reasons why their patients did not receive initial NHT were perceptions about: drug tolerability (38%), lack of clinical trial evidence of overall survival improvement (31%), lack of reimbursement (26%), patient financial constraints (20%), and questions about sequencing NHTs earlier vs later in disease (21%). Regarding treatment goals for PSA response, physicians more frequently reported a relative (%) reduction than an absolute PSA reduction (85% vs 51%). Oncologists considered a median PSA reduction of 50% (IQR 25-75) adequate vs 75% (IQR 50-90) among urologists. Urologists had higher rates of TI at 1L and/or subsequent treatment in patients who were still castration-sensitive (p &lt; 0.01). Physicians who aimed for deeper PSA reduction of 75-100% were more likely (OR = 1.63; p = 0.034) to provide TI in 1L compared with physicians with less aggressive PSA goals (0-49%). Conclusions: To our knowledge, this is the first study identifying reasons for underutilization of intensified treatment in mCSPC. While survey results suggest perceptions of tolerability and lack of efficacy and financial considerations affect NHT use, in practice, non-guideline driven PSA reduction goals are associated with low rates of TI. These results demonstrate the need for further medical education.

Treatment decisions regarding caries and dental developmental defects in children - a questionnaire-based study among Norwegian dentists

BackgroundCurrent knowledge on treatment strategies and choice of restorative materials when treating deep caries or severe dental developmental defects (DDDs) in young individuals is scarce. Therefore, the aim was to investigate Norwegian dentists´ treatment decisions and reasons for treatment choice when treating deep caries in primary teeth and severe DDDs in permanent teeth in children.MethodsA pre-coded questionnaire was sent electronically to all dentists employed in the Public Dental Service (PDS) in Norway (n = 1294). The clinicians were asked about their background characteristics and how often they registered DDDs. Three clinical cases were presented to the dentists and asked to prioritize treatment options and reasons for their choice.ResultsAfter three reminders, 45.8% of the dentists answered. Most clinicians were general practitioners (96.3%), females (77.9%), under 41 year-olds (59.4%), graduated in 2001 or later (61.1%), and representing all regions of Norway. The respondents registered molar incisor hypomineralisation (MIH), other DDDs and dental fluorosis (DF) frequently, 523 (91.1%), 257 (44.8%) and 158 (27.5%), respectively.In case 1a with severe dental caries in a primary molar, the preferred treatment was resin-modified glass ionomer cement (RMGIC) (58.3%), followed by glass ionomer cement (GIC) (17.9%) and zinc oxide-eugenol (ZOE) (13.2%). Extraction, compomer or stainless steel crowns (SSC) were preferred by 0.9, 0.7 and 0.4%, respectively. In case 1b, which was identical to case 1a, but treated under general anaesthesia, the preferred treatment alternatives were RMGIC (37.1%), resin composite (RC) (17.6%) and GIC (17.2%). Extraction and SSC were chosen by 15.1 and 7.2%, respectively. In case 2, showing a severely hypomineralised and symptomatic first permanent molar, the dentists preferred RC (38.4%), followed by RMGIC (26.6%) and GIC (19.0%). Extraction and SSC were chosen by 8.7 and 5.4%, respectively. The treatment choices were not significantly affected by the dentists’ background characteristics. The reasons for dentists’ treatment decisions varied for each patient case; patient cooperation, prognosis of the tooth and own experience were the dominant reasons.ConclusionsA notable disparity in treatment choices was shown indicating that Norwegian dentists evaluate each case individually and base their decisions on what they consider best for the individual patient.

Patterns of care among patients receiving sequential targeted therapies for advanced renal cell carcinoma: A retrospective chart review in the USA

To assess real-world treatment patterns of targeted therapies after failure of first-line tyrosine kinase inhibitors in patients with advanced renal cell carcinoma. A large, retrospective review of medical charts of patients with advanced renal cell carcinoma in the USA was carried out. Descriptive statistics were used to summarize physicians' and patients' characteristics, treatment sequences, and reasons for treatment choices. P-values were calculated using χ2 -tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. A descriptive comparison was carried out between current results and those of a previous treatment pattern study conducted in 2012 to identify changes in treatment patterns over time. Sunitinib and everolimus remained the most commonly-used first and second targeted therapies, respectively. Among patients who continued to a third targeted therapy, everolimus and axitinib were the most commonly-used treatments after second targeted therapy with a tyrosine kinase inhibitor and a mammalian target of rapamycin inhibitor, respectively. The use of pazopanib as first targeted therapy, and of axitinib and sorafenib as second targeted therapies, increased over time. Efficacy, treatment guidelines and a different mechanism of action were the main reasons given by physicians for choosing among second targeted therapies after failure of a first tyrosine kinase inhibitor. The results of the present study document patterns of care during a period of rapid and ongoing therapeutic advancement in advanced renal cell carcinoma. Sequencing of therapies warrants ongoing analysis in light of new agents entering the advanced renal cell carcinoma treatment landscape.

Reasons for Treatment Choices in Knee and Hip Osteoarthritis: A Qualitative Study.

Conservative treatment modalities in osteoarthritis (OA) of the hip or knee are underused, whereas the demand for surgery is rising substantially. To improve the use of conservative treatment modalities, a more in-depth understanding of the reasons for patients' treatment choices is required. This study identifies the reasons for choice of treatment in patients with hip or knee OA. Semistructured in-depth interviews with 24 OA patients were held. Stratified purposive sampling was used to enrich data variation. Interviews were transcribed verbatim and subsequently coded using a thematic approach. Two independent researchers reflected on, compared, discussed, and adjusted the coding. Various treatment modalities were discussed by respondents: medication, exercise, physical therapy, injections, surgery, complementary, and alternative treatment. Four key themes underlying the choice for or against a treatment modality for OA were identified: 1) treatment characteristics: expectations about its effectiveness and risks, the degree to which it can be personalized to a patient's needs and wishes, and the accessibility of a treatment; 2) personal investment in terms of money and time; 3) personal circumstances: age, body weight, comorbidities, and previous experience with a treatment; and 4) support and advice from the patient's social environment and health care providers. The 4 identified key themes enhance the insight of health care providers into the widespread reasons influencing patients' treatment choices for knee or hip OA. This knowledge can be used in clinical practice to aid shared decision making, which may lead to optimized treatment choices for both conservative and surgical treatment.

Reasons for treatment choices in knee and hip osteoarthritis: a qualitative study

Purpose: Conservative treatment modalities in osteoarthritis (OA) of hip or knee are underused, whereas the demand for surgery is rising substantially. Surgery is not always the most effective treatment option, as not all patients are satisfied with the outcomes. To improve utilization of conservative treatment options, more in-depth understanding of reasons underlying patients’ treatment choice is required. Knowing these reasons offers opportunities to optimize conservative treatment options and will aid to inform shared decision-making for patients with hip or knee OA and their healthcare providers. Therefore, the objective of the study was to identify reasons for (conservative and surgical) treatment choices in patients with hip or knee OA. Methods: Semi-structured in-depth interviews with 24 patients with OA were held. Stratified purposive sampling based on gender, age and affected joint (hip or knee) was used to enrich data variation. Recruitment took place in both primary and secondary care. Interviews were transcribed verbatim and subsequently coded using a thematic approach. Two independent researchers continuously reflected upon, compared, discussed and adjusted the coding. Results: Various treatment modalities were discussed by respondents: medication, exercise, physiotherapy, injections, surgery, complementary and alternative treatment. Four key themes of reasons to choose or not to choose for a treatment modality of OA were identified: 1) treatment characteristics: expectations about the effectiveness and risks of a treatment, the degree to which a treatment can be individualized to patients’ needs and desires, and the accessibility of a treatment; 2) personal investment: costs in terms of money and time; 3) personal circumstances: age, weight, comorbidities and previous experience with a treatment; and 4) support and advice: from patients’ social environment and healthcare providers. Conclusions: The four key themes - treatment characteristics, personal investment, personal circumstances and support and advice - give healthcare providers more insight into possible reasons influencing patients’ treatment choices for knee or hip OA. Healthcare providers can use this knowledge in clinical interviews to aid informed shared-decision making, leading to optimized treatment choices.

Structure and importance of patients’ reasons for treatment choices in hip and knee osteoarthritis: a concept mapping study

Structure and importance of patients’ reasons for treatment choices in hip and knee osteoarthritis: a concept mapping study

A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic

BackgroundPatients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make their treatment decisions, as well as the effect of treatment choice on long-term outcomes, is critical to ensuring effective, patient-centered care. This study examined treatment decision-making in a racially diverse, equal-access, contemporary cohort of patients with PCa counseled on treatment options at a multidisciplinary clinic. MethodsA prospective cohort study was initiated at the Walter Reed National Military Medical Center (formerly Walter Reed Army Medical Center) in 2006. Newly diagnosed patients with PCa were enrolled before attending a multidisciplinary clinic. Patients completed surveys preclinic and postclinic to assess treatment preferences, reasons for treatment choice, and decisional regret. ResultsAs of January 2014, 925 patients with PCa enrolled in this study. Surgery (54%), external radiation (20%), and active surveillance (12%) were the most common primary treatments for patients with low- and intermediate-risk PCa, whereas patients with high-risk PCa chose surgery (34%) or external radiation with neoadjuvant hormones (57%). Treatment choice differed by age at diagnosis, race, comorbidity status, and calendar year in both univariable and multivariable analyses. Patients preferred to play an active role in the decision-making process and cited doctors at the clinic as the most helpful source of treatment-related information. Almost all patients reported satisfaction with their decision. ConclusionsThis is one of the first prospective cohort studies to examine treatment decision-making in an equal-access, multidisciplinary clinic setting. Studies of this cohort would aid in understanding and improving the PCa decision-making process.

MP14-05 A PROSPECTIVE COHORT STUDY OF TREATMENT DECISION-MAKING FOR PROSTATE CANCER FOLLOWING PARTICIPATION IN A MULTI-DISCIPLINARY CLINIC

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History III1 Apr 2015MP14-05 A PROSPECTIVE COHORT STUDY OF TREATMENT DECISION-MAKING FOR PROSTATE CANCER FOLLOWING PARTICIPATION IN A MULTI-DISCIPLINARY CLINIC Lauren Hurwitz, Jennifer Cullen, Sally Elsamanoudi, Daniel Kim, Jane Hudak, Maryellen Colston, Judith Travis, Huai-Ching Kuo, and Inger Rosner Lauren HurwitzLauren Hurwitz More articles by this author , Jennifer CullenJennifer Cullen More articles by this author , Sally ElsamanoudiSally Elsamanoudi More articles by this author , Daniel KimDaniel Kim More articles by this author , Jane HudakJane Hudak More articles by this author , Maryellen ColstonMaryellen Colston More articles by this author , Judith TravisJudith Travis More articles by this author , Huai-Ching KuoHuai-Ching Kuo More articles by this author , and Inger RosnerInger Rosner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.867AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make the treatment decisions that they do is critical to ensuring effective, patient-centered care. This study examines treatment decision-making patterns in a racially-diverse, equal-access, contemporary cohort of PCa patients counseled on treatment options at a multi-disciplinary clinic. The characteristics of treated patients are the primary focus of this study. METHODS A prospective cohort study was initiated at Walter Reed National Military Medical Center in June 2006 to examine treatment decision-making patterns among newly-diagnosed PCa patients. Each patient completed surveys pre- and post- participation in a multi-disciplinary clinic to assess patient preferences and reasons for treatment choice. Patients were also assessed for decisional regret and health-related quality of life at 6, 12, 24, and 36 months after treatment. RESULTS As of January 2014, 925 newly diagnosed PCa patients were enrolled in this study. Of the 825 (89%) patients diagnosed with low- and intermediate-risk PCa, 52% chose radical prostatectomy (RP) and 20% chose external beam radiation therapy (EBRT) as primary treatment. In both univariable and multivariable analyses, patients who were older, African-American, and had at least one major comorbidity were significantly more likely to choose EBRT over RP (p<0.001, p<0.001, p=0.003 respectively). Among the 100 high-risk patients, 33% chose RP and 57% chose EBRT plus neo-adjuvant hormones as primary treatment. Age was the only independent predictor of treatment choice in the high-risk PCa group (p=0.0002). Patients cited the reason for choosing RP as: wanting the source of cancer taken out of the body (74%), having confidence in the surgeon (71%), and thinking surgery was a better way to get rid of the cancer (68%). Alternatively, patients reported that the choice to undergo radiation was influenced by: having confidence in the radiation doctor (45%), thinking radiation was a better way to get rid of the cancer (41%), and liking the advances made in radiation technology (40%). CONCLUSIONS This is one of the first prospective cohort studies to examine treatment decision-making in newly diagnosed PCa patients attending a multi-disciplinary clinic. Future studies are planned to examine patients who chose active surveillance, as well as the impact of treatment choice on longitudinal decisional regret and quality of life. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e152 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Hurwitz More articles by this author Jennifer Cullen More articles by this author Sally Elsamanoudi More articles by this author Daniel Kim More articles by this author Jane Hudak More articles by this author Maryellen Colston More articles by this author Judith Travis More articles by this author Huai-Ching Kuo More articles by this author Inger Rosner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment patterns in metastatic renal cell carcinoma: a retrospective review of medical records from US community oncology practices

Background:Vascular endothelial growth factor (VEGF) inhibitors, including targeted therapy with tyrosine kinase inhibitors (TKIs) and the angiogenesis inhibitor bevacizumab, and mammalian target of rapamycin (mTOR) inhibitors are now the standard of care for metastatic renal cell carcinoma (mRCC). However, real-world treatment patterns are not well characterized.Objective:To describe treatment patterns during the first, second, and third lines of targeted therapies for mRCC among community oncologists in the US.Methods:Participating physicians recruited from a nationwide panel each identified up to 15 adult mRCC patients who initiated a second therapy after January 2010. Information extracted from medical records included types of targeted therapies, reasons for treatment choices, patterns of treatment discontinuation, and dose adjustments.Results:Thirty-six physicians contributed charts from 433 mRCC patients. Seventy-seven percent of patients received a VEGF inhibitor as first targeted therapy; 23% received an mTOR inhibitor. Among first-line VEGF users, second-line treatments were 66% mTOR and 34% VEGF inhibitors. Among first-line mTOR users, second-line treatments were 94% VEGF and 6% mTOR inhibitors. Sunitinib followed by everolimus was the most commonly used treatment sequence. Estimated median duration for second targeted therapy was 8.6 months, and median overall survival (OS) and progression-free survival (PFS) were 27.4 and 10.8 months, respectively. Efficacy, treatment guidelines and mechanism of action were the most important considerations for treatment choice.Limitations:Limitations include no adjustment for baseline characteristics, possible difference between physician-defined progression and central review in the clinical trial setting, and limited data availability for axitinib during the study period.Conclusion:In this large retrospective chart review among community oncologists, VEGF–mTOR–VEGF was the most common treatment sequence for mRCC. The most common drugs were sunitinib in the first line and everolimus in the second line.

Real-world patterns of endocrine therapy for metastatic hormone-receptor-positive (HR+)/human epidermal growth factor receptor-2-negative (HER2−) breast cancer patients in the United States: 2002–2012

Objective:Clinical guidelines recommend that patients with HR+/HER2− metastatic breast cancer (mBC), the most prevalent mBC subtype, receive three lines of endocrine therapy (ET) prior to transitioning to chemotherapy (CT) in the absence of need for rapid response, symptomatic visceral disease, or suspected endocrine resistance. Little is known about real-world ET treatment patterns among HR+/HER2− mBC patients.Research design and methods:Post-menopausal women with HR+/HER2− mBC were identified in the MarketScan databases (2002Q3–2012Q2). Patients were classified as receiving either ET or CT as their first therapy post-mBC diagnosis. Those receiving ET were studied further and stratified into three subgroups based on which of the following events occurred first: transition to CT, discontinuation of ET (90 days without evidence of ET), or end of data or insurance eligibility.Main outcome measures:Mean numbers of lines of ET and median durations of each line were summarized for the overall sample and subgroups.Results:Among a total of 19,120 HR+/HER2− mBC patients, 11,545 (60%) initiated an ET; median follow-up time for these patients was 17 months. Seventy-four percent did not receive a second ET. The average patient received 1.36 lines of ET. Among patients with 2+ lines of ET, the duration of each subsequent line was significantly shorter than the previous line. Results were similar in all subgroups.Limitations:Clinical characteristics and reasons for treatment choices are unavailable in claims data.Conclusions:Fewer than two thirds of patients initiated treatment for HR+/HER2− mBC with ET. Among those who did, most received only one line of ET before discontinuation or transition to CT. Patients who received multiple lines of ET experienced shorter durations of therapy with each line. Real-world treatment with ET falls short of the targets recommended by guidelines, representing unmet need for treatment options that improve the effectiveness of endocrine therapy.

Population-based patterns of palliative systemic therapy use in elderly patients with metastatic colorectal cancer (mCRC).

9547 Background: Elderly cancer patients are consistently under-represented in clinical trials, which may lead to under-treatment. Our aims were to 1) determine the impact of advanced age on use of palliative systemic therapy in mCRC, 2) examine the reasons for treatment choices and 3) compare adverse events and treatment discontinuations in elderly vs young patients. Methods: All patients diagnosed with mCRC from 2006 to 2007 and referred to any 1 of 5 regional cancer centers in British Columbia, Canada were reviewed. Summary statistics were used to describe treatment patterns between elderly patients (EP; &gt;/=70 years) and young patients (YP; &lt;70 years). Cox regression models that adjusted for age and confounders were used to determine the effect of systemic therapy on overall survival (OS). Results: We identified 1,013 patients: median age was 67 years (range 23-93); 42% were elderly and 58% were young; 57% were men; and 66% had ECOG 0/1. Compared to YP, fewer EP were offered systemic therapy (46 vs 76%, p&lt;0.001). Among those treated, EP were less likely than YP to be given combination chemotherapy (47 vs 81%, p&lt;0.001) and bevacizumab (19 vs 47%, p&lt;0.001). Most common reasons for no treatment were similar in EP and YP: patient choice (32% for both), poor ECOG (18% of EP and 16% of YP), and significant comorbidities (11% for both). Advanced age alone was also cited as a reason among EP (7%) for not receiving therapy. In the subset that was treated, risk of adverse events (24 vs 14%, p=0.24) and early treatment discontinuations (14 vs 13%, p=0.88) were comparable between EP and YP, respectively. Receipt of systemic therapy was associated with improved OS in both the elderly (HR for death 0.45, 95% CI 0.37-0.56, p&lt;0.001) and the young (HR for death 0.43, 95% CI 0.35-0.53, p&lt;0.001), regardless of age (p interaction of age and treatment &gt;0.05). Conclusions: In this population-based cohort of mCRC, EP were more likely to receive no treatment, monotherapy rather than combination therapy, or a regimen without bevacizumab. In carefully selected EP, however, it appears that rate of adverse events, frequency of early treatment discontinuations, and magnitude of survival benefit from systemic therapy were comparable to YP.

Sequential use of targeted therapies for metastatic renal cell carcinoma: A physician survey and chart review of community oncology practices in the United States.

418 Background: Multiple targeted agents are available to treat metastatic renal cell carcinoma (mRCC) and no consensus has been reached for optimal treatment sequencing. This study describes physician-reported treatment preferences, reasons for treatment choices, and current treatment patterns for mRCC in the community setting. Methods: A physician survey and retrospective chart review was conducted during May and June 2012 among community-based oncologists or hematologists who had ≥5 mRCC patients under their care in 2011. Charts were reviewed for adult mRCC patients initiated on 2nd-targeted therapy after January 2010 to collect information on current treatment sequence in mRCC patients and reasons for treatment choices. A parallel survey collected physician treatment preferences for 1st-, 2nd-, and 3rd-targeted therapies for mRCC patients with good or poor prognosis. Results: The study included surveys from 36 physicians and charts from 433 mRCC patients. The majority of patients (77%) received a tyrosine kinase inhibitor (TKI) and the rest (23%) received a mammalian target of rapamycin inhibitor (mTOR) as the 1st-targeted therapy. Sunitinib was the most common TKI and temsirolimus was the most common mTOR in the 1st-line setting. Among patients receiving 1st-line TKI, 34% received TKI (pazopanib was most used TKI) and 66% received mTOR (everolimus was most used mTOR) in the 2nd-line. Among 1st-line mTOR users, 94% used TKI (sunitinib was most used) and 6% mTOR (everolimus was most used) for 2nd-line. TKI-mTOR-TKI was the most commonly observed treatment sequence. Physician-stated preferences for 1st and 2nd targeted therapies were largely consistent with the results from the chart review, though actual mTOR use in the 2nd-line was greater than expected. Treatment guidelines and evidence from clinical trials were the top-ranked factors impacting treatment choices. Conclusions: In this large, retrospective chart review, TKI-mTOR-TKI was the most commonly observed treatment sequence for mRCC in the community setting.

Use of palliative chemotherapy and targeted agents in elderly patients with metastatic colorectal cancer (mCRC).

6018 Background: Elderly patients are increasingly diagnosed with advanced cancers, but they are consistently underrepresented in clinical trials, which may lead to undertreatment. Our aims were to 1) evaluate the impact of advanced age on patterns of first-line chemotherapy and bevacizumab use in mCRC, 2) examine the reasons for treatment choices and 3) compare adverse events and treatment discontinuations in elderly vs young patients. Methods: A random sample of mCRC patients diagnosed from 2006 to 2007 and referred to any 1 of 5 regional cancer centers in British Columbia, Canada was reviewed. Summary statistics were used to describe treatment patterns between the elderly (&gt;/=70 years) and young (&lt;70 years). Cox regression was used to determine the effect of systemic therapy on overall survival, controlling for age and confounders. Results: We identified 800 patients: 43% elderly and 57% young; 56% men; and 26 / 36 / 38% ECOG 0 / 1 / 2+, respectively. Fewer elderly patients were given chemotherapy (52% vs 79%, p&lt;0.001). Among those treated, most common first-line palliative regimens for elderly vs young included: capecitabine (50 vs 15%), FOLFIRI (26 vs 38%), and FOLFOX (15 vs 37%) (all p&lt;0.001). Those aged &gt;/=70 were also less likely to receive bevacizumab in their regimens (22 vs 50%, p&lt;0.001). The most frequent reasons for no systemic therapy were similar between age groups: patient choice (31 vs 28%), poor ECOG (16 vs 17%), and significant co-morbidity (11 vs 13%). Risk of chemotherapy (p=0.30) and bevacizumab (p=0.39) adverse events were comparable between elderly and young as were rates of early chemotherapy (p=0.07) and bevacizumab (p=0.79) discontinuation. Receipt of systemic therapy +/- bevacizumab was associated with improved survival from mCRC (HR for death 0.50, 95% CI 0.31-0.62, p&lt;0.001), regardless of advanced age (p interaction for age and treatment = 0.33). Conclusions: Elderly patients with mCRC are more likely to receive no chemotherapy, capecitabine monotherapy, or a regimen without bevacizumab. However, in carefully selected elderly patients, adverse events, treatment discontinuations, and overall survival benefit from treatment appear similar to those observed for younger patients.

Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe

Schizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family ( versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.

Epidemiologic study to assess patient involvement in choice of adjuvant chemotherapy for breast cancer (PROSA Study)

The objective of the current study was to assess patient involvement in adjuvant chemotherapy choice, reasons for treatment choice and satisfaction with the chosen treatment, given that improvement in breast cancer survival has been accompanied by a greater demand for disease information from patients. An epidemiologic, prospective, multicentre study was conducted with patients aged over 18 diagnosed with breast cancer stages I, II and III. The study, which was conducted prior to these patients initiating adjuvant chemotherapy, was based on a baseline visit and a follow-up visit. Data on sociodemographic and clinical variables were collected and a survey was administered to assess both the reasons for choosing particular treatments and ultimate satisfaction with the chosen treatment. Statistical procedures included a descriptive analysis, bivariate tests and logistic regression. A total of 613 patients were recruited with a mean (SD) age of 53.3 (10.8) years. Most patients had stage II breast cancer (53.9%) and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 (82.8%). Of these patients, 58.3% were treated with taxanes (48.2% docetaxel, doxorubicin and cyclophosphamide) and 41.7% without (43.5% 5-fluorouracil, epirubicin and cyclophosphamide). At the baseline visit and final visit, 73.8% and 72.6% of patients, respectively, were aware of their diagnosis and prognosis. A total of 77.1% patients (64.7% who had followed their physician's advice) were involved in treatment choice and this involvement was directly related to improved ECOG performance status and information. A total of 78.7% of patients were very satisfied or satisfied with their treatment and 5.4% of patients refused to continue treatment (with 39.3% giving toxicity as the reason). Although a high proportion of patients were involved in choosing their treatment, this involvement was not related to greater treatment satisfaction. Further research in routine clinical settings is needed in order to assess other factors related to choice of adjuvant chemotherapy, treatment satisfaction and long-term effectiveness (3-5 years).

“I Need to Talk About It”: A Qualitative Analysis of Trauma-Exposed Women’s Reasons for Treatment Choice

A significant proportion of individuals suffering from posttraumatic stress disorder do not seek or receive effective treatment. Understanding the reasons why an individual chooses to seek treatment or prefers one treatment to another is a critical step to improve treatment seeking. To begin to understand these reasons, we conducted a qualitative analysis of the reasons women gave for choosing a cognitive-behavioral treatment, prolonged exposure (PE), or a pharmacological treatment, sertraline (SER). A community sample of women with trauma histories were asked to view standardized rationales, to choose among PE, SER, or no treatment, and to give 5 reasons for their choice. Women indicated that they were more likely to prefer the psychotherapy to the medication. Across reasons given, the most commonly cited reason for treatment preference highlighted why or how the treatment worked (e.g., I need to talk about it); and this reason emerged as the strongest predictor of preference for PE. Understanding this role of perceived treatment mechanism may aid clinicians and public health policy officials to identify and address help-seeking barriers regarding treatment.

Predictors of treatment choices and associated outcomes in actinic keratoses: Results from a national physician survey study

Objectives: Actinic keratoses (AKs) are common skin lesions with the potential to progress to squamous cell carcinoma. Many effective treatment alternatives exist, yet the reasons for treatment choice have not been explored. This study examined which AK therapy was preferred among dermatologists and primary care physicians (PCPs), as well as potential determinants of therapeutic selection. Methods: A random national sample of 534 dermatologists and PCPs selected from the American Medical Association database completed AK questionnaires. The final sample included 1184 AK patients treated by dermatologists and 559 AK patients treated and/or referred by PCPs. All analyses were weighted using the survey sampling weights. Results: Patients who had new and recurring lesions as well as patients who had a mean duration of more than a year since the last AK episode treatment (all p<0.05) were more likely to receive pharmacotherapy. Patients being treated by a dermatologist, receiving pharmacotherapy treatment only, and having both new and recurring lesions (all p<0.05) were less likely to have a complete treatment success. Conclusions: This study identifies several patient and physician factors associated with treatment preference and related outcomes in patients being treated for AK.