title: Practice challenges affecting optimal care as identifed by US medical oncologists who treat renal cell carcinomas.
abstract: BACKGROUND
  Approval of new agents provides alternative treatment options for medical oncologists and their patients with renal cell carcinoma (RCC). Treatment decisions remain challenging in the absence of clear evidence supporting optimal selection and sequencing of treatment for different patient or tumor characteristics.
  
  
  OBJECTIVE
  To assess the clinical practice gaps of medical oncologists treating patients with RCC.
  
  
  METHODS
  Medical oncologists practicing in the United States with a case load of 1 or more RCC patient(s) a year were recruited to participate in either an online case-based survey followed by a 45-minute interview (phase 1) or a 15-minute online survey with case vignettes (phase 2). Respondents' answers were compared with treatment guidelines and faculty experts' recommendations.
  
  
  RESULTS
  Qualitative interviews (n = 27) and quantitative surveys (n = 142) were compiled. Clinical performance gaps demonstrating oncologists' diffculties to optimally adjust their treatment plan were identifed. When presented with an RCC patient with treatment-related hypertension, 34% of respondents did not select an expert-recommended option. In a scenario focused on recognizing clinical signs and symptoms as an important component of treatment decision-making, 40% of respondents agreed with the expert-recommended approach. For a progressive patient with chronic obstructive pulmonary disease, 78% of respondents were misaligned with evidence-based treatment options.
  
  
  CONCLUSIONS
  Self-selection and respondent bias may have occurred. Sample size may have limited the statistical power.
  
  
  CONCLUSIONS
  This study identifed clinically relevant performance gaps among US oncologists treating RCC patients. Education to assure familiarity with the most recent changes is needed.
  Pfzer Medical Education Group provided fnancial support through an educational research grant.
authors.affiliation: Axdev Group Inc, Brossard, Quebec, Canada Email: hayess@axdevgroup.com.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Hayes
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Bowser
authors.forename: Jim
authors.initials: J
authors.lastname: Mortimer
authors.forename: Patrice
authors.initials: P
authors.lastname: Lazure
authors.forename: Eric
authors.initials: E
authors.lastname: Peterson
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hutson
authors.forename: Brian
authors.initials: B
authors.lastname: Rini