National survey on prophylactic cranial irradiation: Differences in practice patterns between medical and radiation oncologists

Anthony J. Cmelak, Hak Choy, Yu Shyr, Peter Mohr, Michael J. Glantz, David H. Johnson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose: Prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) patients remains controversial in the oncology community because of its potential for long-term toxicity and unproven survival benefit in randomized trials. A national survey of 9176 oncologists was conducted to characterize the use of PCI with regard to physician demographics, patient characteristics, and oncologists' beliefs. Methods: Data was collected via a questionnaire letter survey. Biographical data, treatment patterns, and clinical impressions were analyzed by the generalized linear model and generalized estimating equations method. Results: There were 1231 responders overall (13.4% of those surveyed), including 628 (51%) radiation oncologists (RO), 587 (48%) medical oncologists (MO), 8 (0.6%) surgical oncologists, and 8 (0.6%) from other oncology subspecialties. Of respondents, 74% overall recommend PCI in limited-stage patients, including 65% of MO and 82% RO (p = 0.001). Of responders who recommend PCI in limited- stage patients, 67% do so only after complete response to initial therapy. Only 30% of respondents recommend PCI for extensive-stage SCLC patients (p = 0.001), and 94% of these recommend PCI only when those patients have a complete response after initial therapy. Interestingly, 38% of responding MO feel that PCI improves survival of limited-stage patients, but only 11% believe PCI improves quality of life. Of the RO, 48% believe PCI improves survival in limited-stage SCLC, and 36% feel PCI improves quality of life (p < 0.05 and p < 0.01, respectively). MO responders believe PCI causes late neurological sequelae more often than do RO responders (95% vs. 84%, p < 0.05), with impaired memory (37%), chronic fatigue (19%), and loss of motivation (13%) as most commonly seen side effects. Only 1.5% overall, however, routinely obtain neuropsychiatric testing in PCI patients, and 42% overall never obtain them. Conclusion: Results confirm that oncologic subspecialists have statistically significant differences in opinion regarding the use of PCI. However, these differences may not translate into large differences in clinical practice. Most oncologists continue to recommend PCI in limited-stage SCLC patients, despite many believing PCI may not provide a survival advantage nor improve quality of life.

Original languageEnglish (US)
Pages (from-to)157-162
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume44
Issue number1
DOIs
StatePublished - Apr 1 1999

Fingerprint

Cranial Irradiation
irradiation
radiation
transponders
Small Cell Lung Carcinoma
lungs
cancer
Survival
Quality of Life
Radiation Oncologists
Surveys and Questionnaires
therapy
physicians
Oncologists
Therapeutics

Keywords

  • Brain metastases
  • Medical oncologists
  • Prophylactic cranial irradiation
  • Radiation oncologists
  • Survey

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

National survey on prophylactic cranial irradiation : Differences in practice patterns between medical and radiation oncologists. / Cmelak, Anthony J.; Choy, Hak; Shyr, Yu; Mohr, Peter; Glantz, Michael J.; Johnson, David H.

In: International Journal of Radiation Oncology Biology Physics, Vol. 44, No. 1, 01.04.1999, p. 157-162.

Research output: Contribution to journalArticle

@article{5fae03ae6be645f28b9f34d641346fbe,
title = "National survey on prophylactic cranial irradiation: Differences in practice patterns between medical and radiation oncologists",
abstract = "Purpose: Prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) patients remains controversial in the oncology community because of its potential for long-term toxicity and unproven survival benefit in randomized trials. A national survey of 9176 oncologists was conducted to characterize the use of PCI with regard to physician demographics, patient characteristics, and oncologists' beliefs. Methods: Data was collected via a questionnaire letter survey. Biographical data, treatment patterns, and clinical impressions were analyzed by the generalized linear model and generalized estimating equations method. Results: There were 1231 responders overall (13.4{\%} of those surveyed), including 628 (51{\%}) radiation oncologists (RO), 587 (48{\%}) medical oncologists (MO), 8 (0.6{\%}) surgical oncologists, and 8 (0.6{\%}) from other oncology subspecialties. Of respondents, 74{\%} overall recommend PCI in limited-stage patients, including 65{\%} of MO and 82{\%} RO (p = 0.001). Of responders who recommend PCI in limited- stage patients, 67{\%} do so only after complete response to initial therapy. Only 30{\%} of respondents recommend PCI for extensive-stage SCLC patients (p = 0.001), and 94{\%} of these recommend PCI only when those patients have a complete response after initial therapy. Interestingly, 38{\%} of responding MO feel that PCI improves survival of limited-stage patients, but only 11{\%} believe PCI improves quality of life. Of the RO, 48{\%} believe PCI improves survival in limited-stage SCLC, and 36{\%} feel PCI improves quality of life (p < 0.05 and p < 0.01, respectively). MO responders believe PCI causes late neurological sequelae more often than do RO responders (95{\%} vs. 84{\%}, p < 0.05), with impaired memory (37{\%}), chronic fatigue (19{\%}), and loss of motivation (13{\%}) as most commonly seen side effects. Only 1.5{\%} overall, however, routinely obtain neuropsychiatric testing in PCI patients, and 42{\%} overall never obtain them. Conclusion: Results confirm that oncologic subspecialists have statistically significant differences in opinion regarding the use of PCI. However, these differences may not translate into large differences in clinical practice. Most oncologists continue to recommend PCI in limited-stage SCLC patients, despite many believing PCI may not provide a survival advantage nor improve quality of life.",
keywords = "Brain metastases, Medical oncologists, Prophylactic cranial irradiation, Radiation oncologists, Survey",
author = "Cmelak, {Anthony J.} and Hak Choy and Yu Shyr and Peter Mohr and Glantz, {Michael J.} and Johnson, {David H.}",
year = "1999",
month = "4",
day = "1",
doi = "10.1016/S0360-3016(98)00557-4",
language = "English (US)",
volume = "44",
pages = "157--162",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - National survey on prophylactic cranial irradiation

T2 - Differences in practice patterns between medical and radiation oncologists

AU - Cmelak, Anthony J.

AU - Choy, Hak

AU - Shyr, Yu

AU - Mohr, Peter

AU - Glantz, Michael J.

AU - Johnson, David H.

PY - 1999/4/1

Y1 - 1999/4/1

N2 - Purpose: Prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) patients remains controversial in the oncology community because of its potential for long-term toxicity and unproven survival benefit in randomized trials. A national survey of 9176 oncologists was conducted to characterize the use of PCI with regard to physician demographics, patient characteristics, and oncologists' beliefs. Methods: Data was collected via a questionnaire letter survey. Biographical data, treatment patterns, and clinical impressions were analyzed by the generalized linear model and generalized estimating equations method. Results: There were 1231 responders overall (13.4% of those surveyed), including 628 (51%) radiation oncologists (RO), 587 (48%) medical oncologists (MO), 8 (0.6%) surgical oncologists, and 8 (0.6%) from other oncology subspecialties. Of respondents, 74% overall recommend PCI in limited-stage patients, including 65% of MO and 82% RO (p = 0.001). Of responders who recommend PCI in limited- stage patients, 67% do so only after complete response to initial therapy. Only 30% of respondents recommend PCI for extensive-stage SCLC patients (p = 0.001), and 94% of these recommend PCI only when those patients have a complete response after initial therapy. Interestingly, 38% of responding MO feel that PCI improves survival of limited-stage patients, but only 11% believe PCI improves quality of life. Of the RO, 48% believe PCI improves survival in limited-stage SCLC, and 36% feel PCI improves quality of life (p < 0.05 and p < 0.01, respectively). MO responders believe PCI causes late neurological sequelae more often than do RO responders (95% vs. 84%, p < 0.05), with impaired memory (37%), chronic fatigue (19%), and loss of motivation (13%) as most commonly seen side effects. Only 1.5% overall, however, routinely obtain neuropsychiatric testing in PCI patients, and 42% overall never obtain them. Conclusion: Results confirm that oncologic subspecialists have statistically significant differences in opinion regarding the use of PCI. However, these differences may not translate into large differences in clinical practice. Most oncologists continue to recommend PCI in limited-stage SCLC patients, despite many believing PCI may not provide a survival advantage nor improve quality of life.

AB - Purpose: Prophylactic cranial irradiation (PCI) in the treatment of small cell lung cancer (SCLC) patients remains controversial in the oncology community because of its potential for long-term toxicity and unproven survival benefit in randomized trials. A national survey of 9176 oncologists was conducted to characterize the use of PCI with regard to physician demographics, patient characteristics, and oncologists' beliefs. Methods: Data was collected via a questionnaire letter survey. Biographical data, treatment patterns, and clinical impressions were analyzed by the generalized linear model and generalized estimating equations method. Results: There were 1231 responders overall (13.4% of those surveyed), including 628 (51%) radiation oncologists (RO), 587 (48%) medical oncologists (MO), 8 (0.6%) surgical oncologists, and 8 (0.6%) from other oncology subspecialties. Of respondents, 74% overall recommend PCI in limited-stage patients, including 65% of MO and 82% RO (p = 0.001). Of responders who recommend PCI in limited- stage patients, 67% do so only after complete response to initial therapy. Only 30% of respondents recommend PCI for extensive-stage SCLC patients (p = 0.001), and 94% of these recommend PCI only when those patients have a complete response after initial therapy. Interestingly, 38% of responding MO feel that PCI improves survival of limited-stage patients, but only 11% believe PCI improves quality of life. Of the RO, 48% believe PCI improves survival in limited-stage SCLC, and 36% feel PCI improves quality of life (p < 0.05 and p < 0.01, respectively). MO responders believe PCI causes late neurological sequelae more often than do RO responders (95% vs. 84%, p < 0.05), with impaired memory (37%), chronic fatigue (19%), and loss of motivation (13%) as most commonly seen side effects. Only 1.5% overall, however, routinely obtain neuropsychiatric testing in PCI patients, and 42% overall never obtain them. Conclusion: Results confirm that oncologic subspecialists have statistically significant differences in opinion regarding the use of PCI. However, these differences may not translate into large differences in clinical practice. Most oncologists continue to recommend PCI in limited-stage SCLC patients, despite many believing PCI may not provide a survival advantage nor improve quality of life.

KW - Brain metastases

KW - Medical oncologists

KW - Prophylactic cranial irradiation

KW - Radiation oncologists

KW - Survey

UR - http://www.scopus.com/inward/record.url?scp=0033048472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033048472&partnerID=8YFLogxK

U2 - 10.1016/S0360-3016(98)00557-4

DO - 10.1016/S0360-3016(98)00557-4

M3 - Article

C2 - 10219809

AN - SCOPUS:0033048472

VL - 44

SP - 157

EP - 162

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 1

ER -