title: Current practices in the management of adverse events associated with targeted therapies for advanced renal cell carcinoma: a national survey of oncologists.
abstract: BACKGROUND
  Oncologists treating patients with targeted therapies encounter adverse events (AEs) that pose management challenges, lead to dosing inconsistencies, and impact patient quality of life. Oncologists' practices and attitudes in the management of targeted therapy-related AEs in patients with renal cell carcinoma (RCC) are poorly understood. We sought to identify unmet needs associated with AE management and understand oncologists' treatment optimization strategies.
  
  
  METHODS
  A 24-item online survey was administered in August 2012 to 119 US oncologists treating patients with advanced RCC. The survey solicited responses regarding demographics, practice settings, AE management practice patterns and beliefs, treatment barriers, and patient education.
  
  
  RESULTS
  Respondents indicated that between 25% and 50% of patients require dose modification/discontinuation because of AEs. The greatest barrier to optimizing treatment for RCC is the unpredictability of patient responses to treatment (43%). Most respondents (78%) discuss AE management with patients, but only a minority of them proactively reach out to patients (46%). Most practitioners (70%) refer patients to nononcology specialists when faced with unfamiliar AEs, although finding interested physicians (43%) and time constraints (40%) were the most commonly cited barriers to consulting with other specialties.
  
  
  CONCLUSIONS
  Results suggest that many patients require dose modification/discontinuation because of AEs and that nononcologists are a frequently utilized resource to manage these events. There is a need for predictive drug toxicity markers to establish counseling and prevention, along with opportunities for increased education on supportive care techniques to maintain health-related quality of life and consistent dosing.
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Stanford School of Medicine, Stanford, CA.
authors.forename: Janelle Nicole
authors.initials: JN
authors.lastname: Ruiz
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Viswanath Reddy
authors.initials: VR
authors.lastname: Belum
authors.affiliation: Duke Cancer Institute, Duke University Medical Center, Durham, NC.
authors.forename: Patricia
authors.initials: P
authors.lastname: Creel
authors.affiliation: Rocky Mountain Cancer Centers, Denver, CO.
authors.forename: Allen
authors.initials: A
authors.lastname: Cohn
authors.affiliation: MD Anderson Cancer Center, Houston, TX.
authors.forename: Michael
authors.initials: M
authors.lastname: Ewer
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: lacoutum@mskcc.org.
authors.forename: Mario E
authors.initials: ME
authors.lastname: Lacouture
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions / Q000628:therapy*; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D058990:Molecular Targeted Therapy / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: Advanced kidney cancer; Anticancer therapy; Oncologist practice patterns; Side effect management practices; Targeted therapy–related side effects