title: Self-reported practices and attitudes of US oncologists regarding off-protocol therapy.
abstract: OBJECTIVE
  Investigational cancer therapies being tested in clinical trials may be available outside of trials, or off-protocol (OPRx). We evaluated the practices and attitudes among US oncologists with regard to this controversial practice.
  
  
  METHODS
  We mailed an anonymous survey to a random sample of US medical oncologists evaluating frequency and prevalence of OPRx and evaluated the correlation between demographic factors, attitudes, and practice.
  
  
  RESULTS
  One hundred forty-six (31%) of 471 oncologists responded. Ninety-three percent reported ever discussing and 81% ever prescribing OPRx. Academic oncologists were more likely than community oncologists to have ever provided OPRx (89% v 75%; P = .06), to discuss OPRx at least once/month (41% v 19%; P = .0004), and to deny requests for OPRx at least once/month (16% v 2%; P = .004). While 61% of oncologists believed that patients should be discouraged from OPRx, only 31% felt it should not be available. With regard to trial recruitment, 53% felt that informed consent requires discussion of OPRx, 34% disagree, and 26% feel that patients should be provided OPRx on request, while 56% disagree. There was lack of consensus on access to OPRx in scenarios based on open trials at the time of the survey, such as adjuvant trastuzumab, which 41% would provide, 59% would not.
  
  
  CONCLUSIONS
  US oncologists report common discussion and use of OPRx, but attitudes and practices may vary substantially. There is need for greater debate regarding OPRx in oncology, further definition of the ethical and clinical issues at stake, and development of guidelines in this area.
authors.affiliation: Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, NC 27710, USA. jeffrey.peppercorn@duke.edu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peppercorn
authors.forename: Harold
authors.initials: H
authors.lastname: Burstein
authors.forename: Franklin G
authors.initials: FG
authors.lastname: Miller
authors.forename: Eric
authors.initials: E
authors.lastname: Winer
authors.forename: Steve
authors.initials: S
authors.lastname: Joffe
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D008495:Medical Oncology; D035703:Therapies, Investigational; D014481:United States