Survey Of Physicians Research Articles

Age and other criteria influencing nontreatment of patients (pts) with locally advanced or metastatic urothelial carcinoma (la/mUC): Results of a physician survey in five European countries (Eu5).

4570 Background: Real-world studies have shown that a majority of pts with la/mUC do not receive first-line (1L) systemic therapy (tx), despite guideline recommendations. This cross-sectional study assessed the criteria that Eu5 physicians consider when making decisions about 1L tx for pts with la/mUC. Methods: A quantitative online survey of Eu5 physicians was performed in Aug-Sep 2022. Respondents answered questions related to demographics, practice patterns, and criteria considered in 1L decision-making. Descriptive statistics were used to analyze demographics and responses. Logistic regression was used to analyze physician characteristics associated with reporting no age threshold vs any age threshold when defining platinum ineligibility. Results: 503 physicians (69% oncologists and 31% urologists) completed the quota-based survey. Most respondents had been in practice for >10 years (69%) and treated 5-19 pts with la/mUC per month (58%) in public teaching hospitals (40%), public nonteaching hospitals (24%), and private hospitals (20%). Physicians estimated that they do not prescribe 1L tx for ≈25% of their pts. The majority of physicians selected advanced age (62.0%) and poor performance status (PS; 54.7%) as their top reasons for not prescribing 1L tx, followed by pt refusal (45.9%) and poor renal function (43.1%). Most physicians (78.1%) reported having an age threshold above which they recommend against 1L systemic tx (mean, 74.7 years old [Table]). After adjusting for baseline characteristics, physicians were more likely to have an age threshold if they were from Italy vs Germany (odds ratio [OR] 0.22 [95% CI 0.06-0.73]), practiced in a public nonteaching hospital (OR 0.28 [95% CI 0.10-0.73]) or public/private office settings (OR 0.14 [95% CI 0.03-0.57]) vs private hospital, and if they treated <20 pts/month (2-10 pts: OR 0.36 [95% CI, 0.17-0.74]; 11-19 pts: OR 0.25 [95% CI 0.09-0.62]). Conclusions: 1L systemic tx rates self-reported by Eu5 physicians were higher than those previously published. Many physicians reported having an age threshold for not offering systemic tx, which was relatively low compared with the senior age profile of the la/mUC population. Physicians who reported an explicit age threshold may be inappropriately excluding pts from tx; this could be a driver for systemic tx underutilization in la/mUC. [Table: see text]

Health-Related Quality of Life Burden Among Adults with Vitiligo: Relationship to Disease Severity and Disease Location.

Vitiligo was historically regarded as a cosmetic disorder; however, it is an autoimmune disease. As a visible condition, it affects patient well-being. We assessed the impact of disease severity, lesion location, and body surface area (BSA) affected on patient health-related quality of life (HRQoL). Retrospective data were from the Adelphi Real World Vitiligo Disease Specific Programme: a cross-sectional survey of physicians and their patients with vitiligo (10/2021-07/2022). Patient-reported outcomes were assessed by the Vitiligo-Specific Quality of Life Instrument (VitiQoL), Hospital Anxiety and Depression Scale (HADS), and EQ-5D-5L. The Work Productivity and Impairment Questionnaire (WPAI) questionnaire was used to assess disease-related impairment of daily activities. Data were stratified by physician-reported disease severity, presence/absence of vitiligo on the face, and BSA percentage affected. In total, 1388 patients were included. Mean (SD) VitiQoL, HADS depression, and anxiety scores were higher for those with severe disease [40.5(26.1), 5.2(4.4), and 6.8(4.7)] than those with mild [24.8(18.8), 3.6(3.8), 4.2(3.8)] or moderate [27.1(22.6), 3.8(4.5), 4.3(4.4)] disease. Patients with face affected reported higher VitiQoL [30.0(22.3) versus 23.2(19.3)], and HADS scores [depression, 4.3(4.3) versus 3.2(3.9); anxiety, 5.0(4.3) versus 3.8 (3.9)] than those without. Patients with ≥ 5% BSA affected had higher VitiQoL, depression and anxiety scores [27.9(21.8), 4.0(4.4), and 4.5(4.2)] than those with 0-5% [24.6(19.7), 3.4(3.7), and 4.3(4.1)]. Patients with severe vitiligo, facial lesions, or ≥ 5% BSA reported higher activity impairment. Mean EQ-5D-5L-utility score was approximately 0.9 regardless of disease severity or total BSA affected. These data demonstrate the impact disease severity can have on HRQoL and daily activities for patients with vitiligo. Lesions that are more severe, on the face, or covering a greater BSA are more often associated with poorer outcomes and activity impairment. These data also highlight the potential insensitivity of commonly used HRQoL measures and a need for more sensitive disease-specific measures.

Recognizing cardiac murmurs in childhood: a survey of physicians’ approaches and knowledge levels

ABSTRACT Objective This study aimed to assess physicians’ approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies. Methods The study intended to include all family physicians in the Adıyaman province of Turkey, but ultimately 150 out of 210 physicians participated and was completed with a percentage response rate of 71%. Participants were asked about their approach to cardiac murmurs, answered knowledge questions, and completed a questionnaire on demographic characteristics. Subsequently, eight heart sounds were played, and participants were asked to identify the nature of each sound. Results Family medicine specialists (all scores were p < 0.001) and physicians who completed a pediatric internship lasting over a month (knowledge score p = 0.012, behavioral score p = 0.021, recording score p = 0.01) demonstrated significantly higher knowledge, approach, and recording scores. Age and years in the profession showed a negative correlation with recording scores. Conclusions The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills.

Chronic coronary artery disease: aspects of recording and coding in clinical practice (results of a survey of physicians)

Aim. To study the opinion of doctors about the applicability, frequency and criteria for practical use of codes of the International Classification of Diseases, 10th revision (ICD-10) from the group of chronic coronary artery disease (CAD) — I25.0, I25.1, I25.8, I25.9.Material and methods. This cross-sectional study was conducted in the period from February 27, 2024 to March 11, 2024 on a continuous sample of medical workers who agreed to participate in an anonymous survey as respondents. The questionnaire consisted of an introductory, personal and main part, which consisted of 19 questions devoted to various aspects of chronic CAD coding at the doctor’s appointment and during preparing medical death certificate. This article presents the results of a survey of cardiologists (group 1) and internists/general practitioners/family physicians (group 2). The χ2 test was used to compare two groups. The Friedman test was used to test the hypothesis that the physicians' opinion about the use of different chronic CAD codes was random. The Kendall test was used to assess the agreement between physicians. Calculations were carried out using Microsoft Office Excel 2021 and SPSS-26.0.Results. A total of 883 doctors from 47 constituent entities of the Russian Federation took part in the survey. Half of the respondents believed that there are differences between the codes I25.0, I25.1, I25.8, I25.9 and that they are necessary for statistical recording. Although cardiologists (59,2%) were less likely than internists/general practitioners/family doctors (65,9%) to believe that one or more of the 4 codes analyzed could be used only on the basis of risk factors, differences did not reach significance (p=0,1). The need to confirm chronic CAD using paraclinical research methods varied from 57,3% for code I25.9 to 83,1% for code I25.1. In case of death of a patient from chronic CAD, almost a third of respondents do not see the differences between the 4 specified codes, but are ready to use them in different clinical setting. In addition, 14,6% responded that when filling out medical death certificates they would not use any of the 4 specified codes. There is no agreement among physicians regarding the use of codes in clinical practice (Kendall's coefficient of concordance 0,084; p&lt;0,001) and as a cause of death (0,148; p&lt;0,001).Conclusion. There is no unified stance among doctors on the rules and applicability of using at least 4 codes (I25.0, I25.1, I25.8, I25.9). To correctly assess morbidity and mortality rates from individual forms of chronic ACAD based on ICD-10 codes, guidelines that should include a description and consideration of all the most significant clinical scenarios of chronic CAD should be developed.

Implementation Strategies to Promote Short-Course Radiation for Bone Metastases

For patients with nonspine bone metastases, short-course radiotherapy (RT) can reduce patient burden without sacrificing clinical benefit. However, there is great variation in uptake of short-course RT across practice settings. To evaluate whether a set of 3 implementation strategies facilitates increased adoption of a consensus recommendation to treat nonspine bone metastases with short-course RT (ie, ≤5 fractions). This prospective, stepped-wedge, cluster randomized quality improvement study was conducted at 3 community-based cancer centers within an existing academic-community partnership. Rollout was initiated in 3-month increments between October 2021 and May 2022. Participants included treating physicians and patients receiving RT for nonspine bone metastases. Data analysis was performed from October 2022 to May 2023. Three implementation strategies-(1) dissemination of published consensus guidelines, (2) personalized audit-and-feedback reports, and (3) an email-based electronic consultation platform (eConsult)-were rolled out to physicians. The primary outcome was adherence to the consensus recommendation of short-course RT for nonspine bone metastases. Mixed-effects logistic regression at the bone metastasis level was used to model associations between the exposure of physicians to the set of strategies (preimplementation vs postimplementation) and short-course RT, while accounting for patient and physician characteristics and calendar time, with a random effect for physician. Physician surveys were administered before implementation and after implementation to assess feasibility, acceptability, and appropriateness of each strategy. Forty-five physicians treated 714 patients (median [IQR] age at treatment start, 67 [59-75] years; 343 women [48%]) with 838 unique nonspine bone metastases during the study period. Implementing the set of strategies was not associated with use of short-course RT (odds ratio, 0.78; 95% CI, 0.45-1.34; P = .40), with unadjusted adherence rates of 53% (444 lesions) preimplementation vs 56% (469 lesions) postimplementation; however, the adjusted odds of adherence increased with calendar time (odds ratio, 1.68; 95% CI, 1.20-2.36; P = .003). All 3 implementation strategies were perceived as being feasible, acceptable, and appropriate; only the perception of audit-and-feedback appropriateness changed before vs after implementation (19 of 29 physicians [66%] vs 27 of 30 physicians [90%]; P = .03, Fisher exact test), with 20 physicians (67%) preferring reports quarterly. In this quality improvement study, a multicomponent set of implementation strategies was not associated with increased use of short-course RT within an academic-community partnership. However, practice improved with time, perhaps owing to secular trends or physician awareness of the study. Audit-and-feedback was more appropriate than anticipated. Findings support the need to investigate optimal approaches for promoting evidence-based radiation practice across settings.

Perspectives from neuro-oncology providers on patient access to electronic records: a survey study.

Aim: To evaluate the neuro-oncology providers' experience with patient online access to electronic records. Methods: Cross-sectional survey for physicians and advanced care providers within the field of neuro-oncology in the USA. Results: 65 providers completed the survey, from all major regions of theUSA. 58%reported that at least once per month, patients contacted them outside of an office visit about provider notes or a laboratory or imaging finding accessed online. 54% of providers did not think that all laboratory results should be released automatically, and only 25% of providers thought that all radiology reads should be released immediately. 97% thought that some patients suffered substantial distress viewing test results prior to appointments. Qualitative responses aligned with the quantitative results. Conclusion: Most neuro-oncology providers are concerned about the immediate release of laboratory and imaging findings to patients without guidance.

Norwegian general practitioners’ perceptions of their depression care – a national survey

BackgroundThe General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs’ workload.ObjectiveTo assess how GPs experience their patients’ expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics.MethodsA cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021.ResultsOf the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40–54 years.ConclusionsTalking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.

Exploring the concept of disease control in chronic cough.

Disease control in chronic diseases is an overarching concept that reflects the degree to which the goals of therapy are met. However, to date, there is no consensus on the definition of disease control in chronic cough. This study aimed to provide a conceptual exploration of patient-reported cough control in chronic cough. This research is comprised of two subanalyses. First, patients with chronic cough receiving care at referral clinics were evaluated. Correlation analyses were performed between patient-reported cough control (a 5-point Likert scale), cough-specific patient-reported outcomes (PROs) and generic health PRO scores. Second, a survey was conducted among patients with refractory chronic cough and physicians to identify factors pertinent to cough control. The analysis of 341 patients (mean age: 55.5±15.1 years; female: 66.6%) revealed that cough control rating was moderately correlated with cough severity visual analogue scale and Leicester Cough Questionnaire scores, while demonstrating weaker correlations with cough-associated throat symptoms, cough-related complications or general health-related quality of life (QoL). In the survey of patients and physicians, both groups considered certain factors, such as cough frequency, severity and impact on QoL, to be relevant to the concept of cough control. However, patients rated "need for cough rescue drug" notably higher than physicians. Patient-reported cough control was associated with cough severity or impact on QoL; however, cough control may not be fully captured by conventional cough PRO measurement tools. Further studies are warranted to define the consensus and tools to measure disease control in chronic cough.

Awareness of Proton Pump Inhibitor Adverse Events and Treatment Pattern Change According to Physician Practice: A National Questionnaire Study in Korea.

Although adverse events of proton pump inhibitors (PPIs) have been reported, there are few studies on physicians' perceptions. We aimed to investigate physicians' awareness of PPI-related adverse events and changes in treatment patterns according to their practice. We conducted an online survey of physicians using a 15-item questionnaire. The survey queried respondents' demographic information, PPI prescription patterns, perceptions, and concerns on the reported PPI-related adverse events. Concerns regarding the adverse events of PPI were assessed by dividing them into possibilities and medical causality. Of the 450 respondents, 430 were specialists, and 232 were gastroenterologists. A total of 87.8% of the respondents were generally or well aware of the adverse effects of PPI, 29.1% considered side effects when prescribing PPI, and 14.6% explained them to patients. Specialists were more aware of the side effects of PPI than general practitioners (p = 0.005), and gastroenterologists were more aware of the side effects of PPI than non-gastroenterologists (p < 0.001). However, gastroenterologists explained less to patients (p = 0.001) and preferred to reduce the dose of PPI rather than discontinue it. The adverse events that were recognized as having the highest probability of occurrence and strongest association with PPI use were bone diseases, Clostridium difficile infection, gastrointestinal infection, pneumonia, and interactions with anti-thrombotic drugs. Physicians' awareness of PPI-related adverse events and treatment patterns differed significantly according to their positions and practice. Although a number of adverse events of PPIs were reported, physicians seem to accept their significance differently according to their specialty and practice patterns.

Results of the Russian Society of Cardiology survey "Chronic heart failure. Unsolved issues"

Aim. To analyze the readiness of the professional medical community for changes in the classification and implementation of novel approaches to heart failure (HF) treatment based on an online survey.Material and methods. Anonymous online survey of physicians on the official website of the Russian Society of Cardiology (www.scardio.ru) "Chronic heart failure. Unsolved issues" was held from September 30 to October 4, 2023. The survey involved 1015 doctors with an average length of work &gt;10 years, mainly cardiologists (n=810, 83,2%).Results. The majority (n=591, 58,2%) of respondents considered it necessary to identify the HF prestage in the classification, similar to prediabetes or prehypertension, while only 2,2% (n=22) of respondents did not consider it necessary to indicate the HF risk in the classification. Simplifying the HF classification based on the left ventricular ejection fraction (LVEF) values with the identification of only two gradations of LVEF &lt;50% and LVEF ³50% was supported by 60,3% (n=612) of specialists.The majority (80,8%) of respondents supported increasing the time of admission of a patient with HF to 30 minutes to ensure the healthcare quality. According to the survey, only 32% of respondents have the ability to determine the brain natriuretic peptide level in patients with HF without restrictions, which indicates insufficient material security for the implementation of clinical guidelines in practice. Quadruple therapy is prescribed to every patient with HF by only 37% of respondents who took part in the survey, which may indicate clinical inertia regarding following the guidelines.Conclusion. In general, the survey demonstrated high awareness of physicians about the problem of HF and readiness to assess the risk and diagnose HF at preclinical stages, as well as a positive attitude towards changing the classification.

Abstract PO3-05-14: Practice patterns for sequential use of antibody-drug conjugate after antibody-drug conjugate in metastatic breast cancer: results from a physician survey

Abstract Introduction: Antibody-drug conjugates (ADCs) have become a key part of metastatic breast cancer (MBC) treatment. Trastuzumab deruxtecan (T-DXd), and Sacituzumab Govitecan (SG) are approved ADCs available for the treatment of MBC. Completed trials that led to the approval of these ADCs did not include patients who had received the other ADC as prior therapy. Little is known about the optimal sequencing of these agents and how clinicians are incorporating ADC sequencing decisions at bedside. Methods: An online survey regarding the use of sequential ADCs was distributed electronically from April 2023 to July 2023 among US clinicians who treat patients with breast cancer. The survey included eight questions assessing clinician practice settings and the use of ADC sequencing and five case-based scenarios (table 1). Descriptive statistics were used to assess survey responses. Results: 107 survey responses were received, out of which 72% were female responders and 93% were medical oncologists. The majority of responders practiced in an academic setting (83%) and reported being involved in clinical research (82%). 58% of responders have been in practice for &amp;gt;10 years and 68% treat &amp;gt;20 breast cancer patients per week. 87% had prescribed an ADC post-ADC for MBC. 46% of responders thought that the degree of benefit for an ADC post-ADC would be similar to the benefit noted in the pivotal ADC trials, and 54% thought that the degree of benefit with sequencing would be lower than in the pivotal trials. Regarding the case-based questions for patients with triple-negative breast cancer and HER2 low disease who had disease progression on first-line metastatic therapy, 64-71% of clinicians opted to give SG as the first ADC followed by T-DXd as the second ADC in sequence, regardless of age, PDL1 status and prior metastatic therapies. For a patient with hormone-positive (HR+), HER2 low MBC, who had received capecitabine as the first metastatic chemotherapy, 50% opted to give T-DXd as the first ADC followed by SG as the second ADC, and 40% opted to give weekly paclitaxel followed by SG as the first ADC. For a patient with HR+, HER2 low MBC who had received two prior chemotherapies for metastatic disease, 77% opted for T-DXd as the first ADC, followed by SG as the second sequential ADC. When grade 1 pneumonitis was added as a comorbidity to the case, only 16% opted to give T-DXd as the first ADC choice. Conclusion: Almost 90% of clinicians report prescribing sequential ADCs for MBC, yet there is little uniformity in how these ADCs are sequenced. More than 50% felt that the benefit of the second ADC in the sequence will be lower than the registration trials that led to the approval of the ADC in a setting of no prior ADC treatment. The optimal sequencing of ADCs remains an area of unmet need and further studies are needed to guide optimal medical decisions regarding sequential ADC-based treatment algorithms for patients with MBC. Table 1. Case-based scenarios for ADC sequencing Citation Format: Yara Abdou, Prarthna Bhardwaj, Rachel Abelman, Laura Spring, Aditya Bardia, Lisa Carey, Priyanka Sharma. Practice patterns for sequential use of antibody-drug conjugate after antibody-drug conjugate in metastatic breast cancer: results from a physician survey [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-05-14.

Treatment patterns in advanced/metastatic non-small-cell lung cancer in China: results from the CancerMPact® survey 2021.

Aim: To report the treatment patterns of advanced/metastatic non-small-cell lung cancer (NSCLC) in China from a physician survey (CancerMPact®). Materials & methods:A total of206 Chinese physicians from 27 cities in urban mainland China reported on their treatment of NSCLC in September 2021. Results: Platinum doublets received 70.5% utilization for squamous NSCLC with PD-L1 expression <1% in first-line, whereas nonsquamous NSCLC was treated with platinum doublets (35.2%) or bevacizumab with platinum doublets (35.3%). Checkpoint inhibitors were utilized in >50% of all PD-L1-positive NSCLC cases. Driver-mutated NSCLC was most frequently treated with targeted therapy or platinum-based combinations. Conclusion: NSCLC treatment in China varies by histology, PD-L1 statusand driver mutations, illustrating the complexity of decision-making for Chinese physicians as treatment markets expand.

Abstract PO1-06-08: Treatment utilization by race and insurance type among triple negative breast cancer patients

Abstract Introduction Triple negative breast cancer (TNBC) is associated with poorer prognosis and its lower long-term survival rates disproportionately affect people of racial and ethnic minority groups. Ensuring timely and effective treatment for all patients regardless of race or insurance status is critical. The objective of this study is to describe treatment patterns by line of therapy, race, and insurance type to identify barriers to accessing healthcare using a physician survey and patient-chart review. Methods This study employed a 60-minute physician survey and linked retrospective chart review of patients’ charts conducted June-July 2022. Participating oncologists across the US (34% Central; 19% Southeast; 18% Northeast; 21% West; 9% East Coast) were required to be board-certified, in practice 3 to 30 years post-residency, and managing at least 7 patients with TNBC in the past 3 years. Oncologists extracted patient-level data from 2-4 patient records for the chart review. A convenience sample of charts oversampled patients on Medicaid, Black and Latina patients, and patients with later stage TNBC to allow for robust disparities analysis. Data collection included provider characteristics, treatment by line of therapy (LOT), rationale for treatment decisions, barriers experienced in accessing care, and support services used. Results Participating oncologists (n=101, 73% male; 62% community vs 39% academic setting) provided data on 283 patients with TNBC [99% female; median age = 46.0 years; race = Black (42%), Latina (31%), White (25%) or Other (2%); geographic location = Urban (53%), Suburban (39%), Rural (8%)]. White patients were more likely to be covered by private insurance (73%) compared to Black (25%) and Latina patients (32%). Black and Latina patients were more likely to be covered by Medicaid (White, 16%; Black, 71%; Latina, 52%). Over half of patients needed prior authorization for first-line (1L) treatment; mean wait time for prior authorization was 1.5 weeks. Black patients (58%) were more likely to require prior authorization in 1L as compared to White patients (49%); There were no significant differences in prior authorization requirements based on type of insurance (Medicaid, Medicare, Private/Commercial Insurance). Of the 283 patients treated with 1L therapy, 111 patients received second-line (2L) treatment [Black (n=52, 44%), Latina (n=29, 32%), White (n=26, 37%), Other (n=4, 71%)], and 45 patients received third-line (3L) treatment [Black (n=25, 21%), Latina (n=9, 10%), White (n=9, 13%), Other (n=2, 33%)]. Chemotherapy was the most common 1L (75%) and 2L (51%) treatment. Targeted therapy (TT), defined as immunotherapy, hormone therapy or antibody–drug conjugates, was most common in 3L (64%). A smaller proportion of Black patients who progressed to 3L received TT (n=13, 52%) compared to White (n=8, 89%) and Latina (n=7, 78%) patients. A larger proportion of patients with private/commercial insurance (n=18, 95%) received TT in 3L as compared to patients with Medicaid (n=10, 42%) or Medicare (0%). Conclusions Findings indicated disparities both in pre-treatment barriers (specifically prior authorization) and the utilization of targeted therapy in later lines of therapy among Black patients. Although treatment patterns did not seem to differ by race in early lines of therapy, numerical differences in treatment patterns by race and insurance type emerged in later lines of therapy. Given the poor prognosis for patients diagnosed with TNBC and its disproportionate impact on communities of color, future policy efforts should be focused on achieving equity in treatment initiation and use of TT in TNBC patients. Citation Format: Natalia Sadetsky, Langa Bakhuluma-Ncube, Emily Fox, Laura Okpala, Matt O'Hara, Jennifer Parr. Treatment utilization by race and insurance type among triple negative breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-06-08.

Abstract PO2-05-02: Real-world experience of patients receiving treatment for hormone receptor-positive/human epidermal growth factor receptor-2 negative metastatic breast cancer: A global analysis of symptoms and side effects

Abstract Background: Advances in treatment for patients (pts) with hormone receptor-positive (HR+)/human epidermal growth factor receptor-2 negative (HER2–) metastatic breast cancer (mBC) have improved overall survival, but treatment resistance is common and median survival remains only a few years. These pts usually need chronic therapy and often experience symptoms and side effects. There is limited knowledge on pts’ experiences outside the clinical trial setting, largely because this information is not routinely reported. This analysis leverages a unique database of physician- and pt-reported data to describe symptoms and side effects among a real-world, geographically diverse population of pts receiving treatment for HR+/HER2– mBC. Methods: This retrospective cohort study used Adelphi Disease Specific Programme Real World Data, comprising validated, linked pt and physician questionnaire data from the US, France, Germany, Italy, Spain, and UK. Eligible pts were ≥18 y, currently receiving treatment for advanced BC and not enrolled in a clinical trial. Data were collected between August 2022 and February 2023. Physician surveys provided data on individual pt demographics and disease characteristics, comorbidities, treatment history, and treatment (including adherence). Physicians also reported presence or absence of symptoms and side effects after treatment initiation for each pt they considered. A subset of pts completed one-time validated quality of life (QOL) instruments, including the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and EORTC QLQ-breast (BR23). Results: Data from 1578 pts receiving treatment for HR+/HER2– mBC were analyzed. Mean age was 65-y, 91% were white, 71% had de novo mBC, and 82% had ECOG performance status 0-1 at the start of current treatment. Across all lines of therapy, 71% of pts were receiving endocrine-based therapy, 16% were receiving chemotherapy only, and 13% were receiving other therapies; 40% of all pts were receiving second or later lines of any systemic therapy (2L+). Among all pts, the most common physician-reported symptoms and side effects (in ≥10% of pts) were bone pain (30%), change in appetite (13%), weight loss (12%), neutropenia (11%), and joint/muscle pain (11%). Pts on 2L+ therapy experienced a greater frequency of symptoms and side effects than those on first-line therapy (Table). Of 220 pts who completed QOL questionnaires, the most commonly reported symptoms and side effects (in ≥70% of pts) were feeling tired (87%), worry about future health (80%), general worrying (79%), needing to rest during the day (74%), feeling weak (74%), having trouble doing strenuous activity (71%), and trouble taking a long walk (71%). These were common irrespective of pt age, disease state (recurrent vs de novo), current treatment regimen, and line of therapy. Conclusions: This real-world analysis shows that both physicians and pts identified substantial symptoms and side effects during treatment. These were pervasive across the population and more common in those receiving 2L+ therapy, although it remains unclear which were due to treatment or disease. Thus, it is important to continue to develop treatments and supportive care to improve both clinical outcomes and pt QOL. Citation Format: MK Rehnquist, Ann Partridge, Annabel Lambert, Allison Kurian, Natalia Sadetsky, Emily Freeman, Lisa Carey. Real-world experience of patients receiving treatment for hormone receptor-positive/human epidermal growth factor receptor-2 negative metastatic breast cancer: A global analysis of symptoms and side effects [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-05-02.

Perceived Barriers to Pursuing a Career in Neurosurgery in Nigeria: A Cross-Sectional Survey of Nigerian Medical Students and Unspecialized Physicians

Nigeria has an inadequate number of neurosurgeons to meet the population's demand for neurosurgical care. Furthermore, few Nigerian neurosurgeons are female. This study sought to evaluate perceived barriers to pursuing neurosurgery among Nigerian trainees. A 60-question survey was distributed electronically to medical students at the College of Medicine, University of Ibadan, and unspecialized intern physicians at the University College Hospital, Ibadan, Nigeria. Participation was voluntary. One hundred fifty-seven respondents participated in the survey. A greater proportion of males indicated an interest in neurosurgery than females (40% vs. 18%, P= 0.010). Over 75% of respondents identified decreased family and personal time, long work hours, and limited access to maternity or paternity leave as potential barriers to neurosurgery, with no differences by gender. Respondents overall saw being female and low-income as disadvantageous to pursuing neurosurgery in Nigeria. Although they universally viewed research as important in neurosurgery, 59% of respondents reported inadequate access to research opportunities; this did not vary by gender. However, 65% of female respondents reported that having a female neurosurgery mentor would increase their interest in neurosurgery (vs. 37% of males, P= 0.001). Nigerian medical trainees perceived the time commitment of neurosurgery as a major barrier to pursuing the specialty. Regardless of gender, they also reported low exposure to neurosurgery and inadequate access to research and mentorship opportunities. However, we found that enhanced female representation among neurosurgery mentors and improved work-life balance could increase interest in neurosurgery and help expand Nigeria's neurosurgical workforce.

Parent, Physician, and Therapist Experience of In-Person, Hybrid, and All-Virtual Models of Physiatry Care for Children with Special Health Care Needs

ObjectiveThe purpose of this study was to compare three models of pediatric physiatry care (in-person, hybrid, and all-virtual) in terms of parent experience and physician- and therapist-reported quality of care. We hypothesized that the all-virtual model would have lower parent experience scores and lower quality scores compared with the other two models of care. MethodsWe designed a convergent parallel mixed methods study incorporating a cluster-randomized crossover design. Quantitative data included surveys of parents, physicians, and therapists after visits to 13 medical therapy units in Northern California between January 2020 and January 2022. Qualitative data were collected in six focus groups with parents, physicians, and therapists. ResultsA total of 2455 visits were completed for 1281 unique children during the study period, including 507 in-person visits, 246 hybrid visits, and 1702 all-virtual visits. There were no differences in parent experience scores between the three models of care. Physicians and therapists rated all-virtual visits significantly lower in terms of quality of care, parent education, and physical exam, compared with the other two models of care, but qualitative results highlighted specific instances where all-virtual visits could be useful. ConclusionsOur findings suggest that parents, therapists, and physicians find a hybrid virtual model is an acceptable model of care that maintains the quality of care and facilitates parent education. All-virtual models may be appropriate for specific circumstances but are perceived as lower quality. Research exploring implementation of these models would be valuable for providing practical guidance in the future.

Attitudes and Beliefs Regarding Pain Medicine: Results of a National Palliative Physician Survey

ContextPain is a prevalent symptom in patients with serious illness and often requires interventional approaches for adequate treatment. Little is known about referral patterns and collaborative attitudes of palliative physicians regarding pain management specialists. ObjectivesTo evaluate referral rates, co-management strategies, and beliefs of palliative physicians about the value of Pain Medicine specialists in patients with serious illness. MethodsA 30-question survey with demographic, referral/practice, and attitudes/belief questions was mailed to 1000 AAHPM physician members. Responses were characterized with descriptive statistics and further analyzed for associations between training experiences, practice environment, and educational activities with collaborative practice patterns and beliefs. ResultsThe response rate was 52.6%. Most survey respondents had initial board certification primarily in internal medicine (n = 286, 56%) or family medicine (n = 144, 28%). A minority of respondents had completed a formal ABMS Hospice and Palliative Medicine fellowship (n = 178, 34%). Respondents had been in practice for a median of nine years, (range 1-38 years) primarily in community hospitals (n = 249, 47%) or academic hospitals (n = 202, 38%). The variables best associated with collaborative practices and attitudes was practice in an academic hospital setting and participation in regular joint academic conferences with pain medicine clinicians. ConclusionThis study shows that Palliative Care physicians have highly positive attitudes toward Pain Medicine specialists, but referrals remain low. Facilitating professional collaboration via joint educational/clinical sessions is one possible solution to drive ongoing interprofessional care in patients with complex pain.

Smoking cessation counselling patterns in cancer patients - survey of Lebanese physicians.

Tobacco smoking is a known risk factor for cancer development and smoking cessation can lower this risk and improve outcomes in some cancer patients. Despite that, many cancer patients do not quit smoking after a cancer diagnosis, and smoking cessation counselling is still not routinely provided in cancer care. The aim of this study is to examine patterns in smoking cessation counselling to cancer patients by their treating physicians. A self-administered, web-based (mobile-friendly), anonymous questionnaire was developed on LimeSurvey and sent by e-mail to Lebanese physicians of different specialties between June 2020 and January 2022. Data were analysed using SPSS and associations between the different items were determined using the χ2 test. A total of 146 physicians filled out the questionnaire. Almost all physicians ask cancer patients about their smoking status, but only 45.9% provide smoking cessation counselling, and only 24% refer patients to smoking cessation counselling programs. Only 27.4% of all respondents have received formal smoking cessation training, and only 27.4% feel capable of providing smoking cessation counselling in their clinic. Specifically, family medicine physicians were more likely to provide smoking cessation counselling in the clinic (69%), more likely to refer patients to a smoking cessation counselling program (44%), and more likely to have received formal smoking cessation counselling training (67%) and more likely to feel capable of providing smoking cessation counselling (93%). Lack of training, lack of knowledge of available programs and the lack of availability of enough programs are leading obstacles contributing to low rates of smoking cessation counselling in cancer patients as reported by the physicians. Our data reveals a deficiency in smoking cessation counselling and referral of cancer patients to smoking cessation counselling programs in our region. This highlights the need for dedicated smoking cessation counselling training for practicing physicians and physicians in training.

Fluid management and active fluid removal practices: a global survey of paediatric critical care physicians

AimsFluid accumulation (FA) in critically ill children is associated with poor clinical outcomes. While conservative fluid management has been proposed, evidence to guide practice is scarce. We surveyed paediatric critical care (PCC) physicians worldwide regarding their perceptions of FA, active fluid removal (AFR) practices, safety parameters, and willingness to participate in a clinical trial on the topic.MethodsCross-sectional international electronic survey of PCC physicians, distributed through research networks worldwide.ResultsA total of 409 PCC physicians from 48 countries participated in the survey; 40% (164/409) cared for cardiac patients. The majority believed FA was a modifiable source of morbidity (88%, 359/407) and expressed support for a trial on conservative fluid management trial (94%, 383/407). Restriction of maintenance fluid was more commonly practiced (87%, 335/387) than resuscitation fluid (54%, 210/387), with variability observed among individuals and patient categories. AFR was widely practiced (93%, 361/387), yet significant differences existed in patient selection, timing, modality, and rate. The most common reported time for starting AFR was 48 h (49%, 172/384), with most respondents (92%, 355/385) comfortable doing so in the setting of catecholamine infusions. While most respondents would continue diuretics with mild electrolyte or acid–base disturbances, 52% (179/342) would withhold them in cases of mild hypotension.ConclusionsFluid accumulation remains a significant concern among paediatric intensivists. The observed practice variability underscores the challenges in establishing evidence-based guidelines. Our survey highlights an urgent need for randomized trials in this field and provides valuable insights to inform the design of such future studies.

Patterns of interactions among ICU interprofessional teams: A prospective patient-shift-level survey approach.

The Awakening, Breathing Coordination, Delirium monitoring and Early mobility bundle (ABCDE) is associated with lower mortality for intensive care unit (ICU) patients. However, efforts to improve ABCDE are variably successful, possibly due to lack of clarity about who are the team members interacting when caring for each patient, each shift. Lack of patient shift-level information regarding who is interacting with whom limits the ability to tailor interventions to the specific ICU team to improve ABCDE. Determine the number and types of individuals (i.e., clinicians and family members) interacting in the care of mechanically ventilated (MV) patients, as reported by the patients' assigned physician, nurse, and respiratory therapist (RT) each shift, using a network science lens. We conducted a prospective, patient-shift-level survey in 2 medical ICUs. For each patient, we surveyed the assigned physician, nurse, and RT each day and night shift about who they interacted with when providing ABCDE for each patient-shift. We determined the number and types of interactions, reported by physicians, nurses, and RTs and day versus night shift. From 1558 surveys from 404 clinicians who cared for 169 patients over 166 shifts (65% response rate), clinicians reported interacting with 2.6 individuals each shift (physicians: 2.65, nurses: 3.33, RTs: 1.86); this was fewer on night shift compared to day shift (1.99 versus 3.02). Most frequent interactions were with the bedside nurse, attending, resident, intern, and RT; family member interactions were reported in less than 1 in 5 surveys (12.2% of physician surveys, 19.7% of nurse surveys, 4.9% of RT surveys). Clinicians reported interacting with 3-4 clinicians each shift, and fewer on nights. Nurses interacted with the most clincians and family members. Interventions targeting shift-level teams, focusing on nurses and family members, may be a way to improve ABCDE delivery and ICU teamwork.