Differences of opinion: a survey of knowledge and bias among clinicians regarding the role of chemotherapy in metastatic non-small cell lung cancer.
OBJECTIVE
To quantify clinician knowledge and bias regarding the role of chemotherapy for stage IV non-small cell lung cancer (NSCLC).


METHODS
A 16-question, multiple-choice questionnaire was sent to all Australian general internists, pulmonary and palliative care physicians, medical and radiation oncologists, and thoracic surgeons to assess beliefs concerning the role of chemotherapy in metastatic NSCLC. An overall assessment of "pessimism" and "optimism" regarding the role of chemotherapy in metastatic NSCLC was made, and knowledge of specific outcome measures was evaluated.


RESULTS
A total of 1,325 questionnaires were mailed, with 679 replies (51%) received and 544 replies (41%) assessable. Overall, 60% of respondents were deemed to have good knowledge. There was a wide variation in knowledge between specialist groups (p < 0.0001), with more medical oncologists (76%) but fewer thoracic surgeons (35%) and general internists (50%) with good knowledge. Fewer medical oncologists (6%) were classified as pessimistic compared with palliative care physicians (31%), radiation oncologists (28%), or pulmonary physicians (22%). Sixty-eight percent of respondents agreed that most patients receiving chemotherapy have symptomatic improvement. More medical oncologists (77%) and pulmonary physicians (73%), but fewer general internists (55%) and palliative care physicians (57%) agreed with this. Medical oncologists were far more likely to agree that chemotherapy was of benefit in patients aged > or = 70 years compared with any of the other specialist groups.


CONCLUSIONS
There were significant differences regarding the perceived role of chemotherapy in metastatic disease between the various specialty groups involved in the treatment of NSCLC. Many clinicians had a poor understanding of contemporary data regarding the use of chemotherapy in metastatic NSCLC. This study raises substantial issues regarding the beliefs of clinicians treating NSCLC and emphasizes the importance of multidisciplinary assessment.
Jennens
Ross R
RR
Department of Medical Oncology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. ross.jennens@petermac.org
de Boer
Richard
R
Irving
Louis
L
Ball
David L
DL
Rosenthal
Mark A
MA
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000556:secondary*; D003625:Data Collection; D004522:Educational Status; D006801:Humans; D007388:Internal Medicine; D008175:Lung Neoplasms / Q000473:pathology*; D008495:Medical Oncology; D008511:Medicine; D008875:Middle Aged; D009520:New Zealand; D010166:Palliative Care; D015272:Pulmonary Medicine; D013038:Specialization; D013903:Thoracic Surgery