Survey of Primary Care Physicians on Therapeutic Approaches to Lung and Breast Cancers

Abdolmohammadi, Alireza; Sears, William; Rai, Sheth; Pan, Jianmin; Alexander, Joseph L.; Kloecker, Goetz

doi:10.14423/smj.0000000000000134

Cited by 3 publications

(2 citation statements)

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“…Documented reasons for not making a referral appear largely non-modifiable at the time of referral ( Figure 4); however, other complex systematic factors also likely contribute. Despite guidelines that assist primary care physicians in referring advanced lung cancer patients, therapeutic nihilism among primary care physicians might be persistent 21,[26][27][28] . A delay in diagnosis might also have contributed, because data suggest that, within the current Canadian infrastructure, wait time from abnormal imaging to diagnosis and treatment of lung cancer remains in excess of 60-90 days across the country [29][30][31][32] .…”

Section: Discussionmentioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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Introduction Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival (p < 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months, p = 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16; p = 0.008] and pulmonary embolus (hr: 1.2; p = 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5; p < 0.001) and enrolment in a clinical trial (hr: 0.76; p = 0.049) correlated with better survival. Methods ConclusionsOur experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.

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Section: Discussionmentioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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“…Both objective factors, such as treatment guidelines, and subjective factors, such as physician preferences, have been shown to influence physicians' disease management recommendations and treatment patterns for their BC patients . While several studies have focused on physician variability in treating early BCs , there is limited information on physician treatment preferences for advanced BC and their real‐world prescribing experiences . The objective of this physician survey is to describe physicians' preferences and self‐reported prescribing patterns in treating HR+/HER2− mBC among community oncology practices in the United States.…”

Section: Introductionmentioning

confidence: 99%

Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

et al. 2015

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Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor‐positive (HR+)/human epidermal growth factor receptor 2‐negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self‐reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community‐based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET‐based regimens versus CT and by agent for postmenopausal HR+/HER2− mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating mBC. Among first‐line ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus‐based (EVE, 34%) and fulvestrant‐based (FUL, 15%) therapy. After first‐line ET, the most preferred second‐ and third‐line treatments were ET monotherapy (48% and 39%), ET combination therapy (31% and 19%), and CT monotherapy (13% and 30%). Comparing EVE versus FUL, physicians preferred EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for HR+/HER2− mBC in community practice suggested that after first‐line ET, ET mono‐ or combination therapy was commonly used for the second‐ and third‐line treatments and CT monotherapy for third‐ or later line treatments. CTs were used in early lines for patients with visceral symptoms.

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General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China

et al. 2015

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BackgroundThe primary care in China can be provided by general practitioners (GPs) and other physicians (non-GPs). However, China’s general practice system has never been really established. Chinese patients tend to consider the quality of primary care provided by GPs much lower than that of non-GPs. Besides, many GPs presently prefer leaving their own positions and seeking better development in big hospitals, which has made the already weak GP system weaker. Yet, few studies have specially compared the quality of primary care provided by Chinese GPs and other physicians and no studies have explored the independent predictors of Chinese GPs’ intentions to stay on their current job. In this study, we aimed to compare the quality of primary care offered by GPs with non-GPs and to explore the independent predictors of GPs’ future work intentions.MethodsThis cross-sectional study applied multi-stage random cluster sampling methodology. The data were collected from November 2013 to September 2014 in Guangdong Province. In total, 401 effective questionnaires were selected from the physicians. Quality of primary care was assessed using the Primary Care Assessment Tool (PCAT) Provider Part, representing six primary care domains: ongoing care, coordination (i.e., referrals and information systems), comprehensiveness (i.e., service available and service provided), family-centeredness, community orientation and cultural competence.ResultsOf 401 participating physicians, 163 (40.6 %) were GPs. The total PCAT score was 26.32 ± 2.24 which was the sum score of the six domains and represent the quality of primary care. GPs achieved significantly different total scores and scores on three individual scales: comprehensiveness: service available, comprehensiveness: service provided and community orientation. Multiple linear regressions revealed GPs had a higher total score and scores for comprehensiveness: service provided and community orientation after adjusting for sociodemographic characteristics. In addition, GPs were more likely to intend to stay in their current job in the coming year, and this was associated with their educational level.ConclusionsOur findings showed that GPs reported higher quality of primary care than other physicians, and were more inclined to stay in their current job. With more comprehensive care and community orientation provided by GPs, residents could reach basic medical cares and needn’t to crowd into larger hospitals.

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Survey of Primary Care Physicians on Therapeutic Approaches to Lung and Breast Cancers

Cited by 3 publications

References 1 publication

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China

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