title: Patients' Attitudes and Physicians' Perceptions Toward Maintenance Therapy for Advanced Non-Small-cell Lung Cancer: A Multicenter Italian Survey.
abstract: Pemetrexed maintenance therapy (MT) after induction with platinum-based chemotherapy has recently become a common treatment strategy for advanced nonsquamous non-small-cell lung cancer (NSCLC). However, the benefits of MT should be weighed with consideration of the patients' perceptions and preferences. The aim of the present study was to evaluate patients' attitudes toward MT and to describe physicians' awareness of their patients' inclinations.
  
  
  
  We administered a 12-question anonymous survey and the Distress Thermometer Questionnaire to patients with advanced or recurrent nonsquamous NSCLC. The survey was also distributed to the referring physicians.
  
  
  
  From December 2014 to July 2015, 92 patients and 37 physicians were enrolled. All 92 patients completed the questionnaire at T0 (before starting chemotherapy) and 56.5% also did so at T1 (after completion of induction). The physicians completed the survey only at T0. Most patients had a positive attitude toward MT at both T0 (78.9%) and T1 (86.5%), and 100% of the physicians thought their patients would be in favor of MT. The physicians believed that their patients' attitudes toward MT would decrease proportionally with the reduction in the magnitude of the overall survival increase and expected benefits. The decrease expected by the physicians was much greater than that reported by the patients. This was especially true for an overall survival increase as small as 1 month (51.9% of patients accepting MT vs. 13.5% supposed by physicians) or when the only treatment benefit was radiologic tumor stabilization (69.3% of patients accepting MT vs. 37.8% supposed by physicians).
  
  
  
  NSCLC patients have a generally positive attitude toward MT, which is not directly proportional to the expected benefits and greater than the attitude expected by physicians.
authors.affiliation: Department of Oncology, University of Turin, Orbassano, Italy. Electronic address: mvpacchiana@yahoo.it.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Pacchiana
authors.affiliation: Department of Oncology, University of Turin, Orbassano, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Capelletto
authors.affiliation: Department of Oncology, University of Turin, Orbassano, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Carnio
authors.affiliation: Division of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
authors.affiliation: Division of Medical Oncology, S.G. Moscati Hospital, Avellino, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Clinical Cancer Center "Giovanni Paolo II", Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.affiliation: Clinical Cancer Center "Giovanni Paolo II", Bari, Italy.
authors.forename: Elisabetta Sara
authors.initials: ES
authors.lastname: Montagna
authors.affiliation: Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bordi
authors.affiliation: Medical Oncology Unit, Regina Elena Cancer Institute, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ceribelli
authors.affiliation: Medical Oncology Unit, San Gerardo Hospital, Monza, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cortinovis
authors.affiliation: Oncology Department, Radiation Therapy Unit, Careggi Hospital, Florence, Italy.
authors.forename: Vieri
authors.initials: V
authors.lastname: Scotti
authors.affiliation: Medical Oncology Unit, San Giovanni Addolorata Hospital, Rome, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Martelli
authors.affiliation: Medical Oncology Unit, E. Morelli Hospital, Sondalo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Valmadre
authors.affiliation: Medical Oncology Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Conte
authors.affiliation: Medical Oncology Unit, D. Camberlingo Francavilla Fontana Hospital, Brindisi, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Miccianza
authors.affiliation: Medical Oncology Unit, Saronno Hospital, Saronno, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Morena
authors.affiliation: Oncology and Hematology Unit, ULSS 13, Mirano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rosetti
authors.affiliation: Department of Oncology, University of Turin, Orbassano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.affiliation: Department of Clinical and Biological Science, University of Turin, Orbassano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ostacoli
authors.affiliation: Department of Oncology, University of Turin, Orbassano, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Novello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001290:Attitude; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D000068437:Pemetrexed / Q000627:therapeutic use; D010465:Perception; D017671:Platinum Compounds / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D017671:Platinum Compounds; D000068437:Pemetrexed
keywords: Doctor-patient relationship; Maintenance therapy; NSCLC; Patients' perceptions; Quality of life