title: Perceptions of cancer of unknown primary site: a national survey of Australian medical oncologists.
abstract: BACKGROUND
  Despite being the sixth most common cause of cancer death in Australia, cancer of unknown primary (CUP) site remains poorly understood.
  
  
  OBJECTIVE
  To describe practices relating to the diagnosis, investigation, classification, communication and management of CUP among medical oncologists.
  
  
  METHODS
  We invited all members of the Medical Oncology Group of Australia to participate in a national, anonymous online survey about CUP. The survey collected data regarding diagnosis acceptance, diagnostic tests, treatment protocols and communication practices around the diagnosis of CUP.
  
  
  RESULTS
  Three hundred and two oncologists were invited and 86 (28%) completed the survey. Eighty (93%) respondents were directly involved in the assessment of patients with CUP. Eighty-five (99%) respondents were prepared to make a diagnosis of CUP if, after appropriate diagnostic tests, the primary location could not be ascertained. Eighty-three percent would assign a primary site to obtain Pharmaceutical Benefits Schedule funding of medical therapy. Sixty-two percent did not have a specific treatment protocol designed for CUP. The majority of oncologists used serum tumour markers and computed tomography scans in the initial work-up, while 43% indicated they would use a positron emission tomography scan in the majority of cases. The majority would arrange mammography in female patients. Thematic analysis of responses to open-ended questions about how CUP is described identified little consistency in the language being used.
  
  
  CONCLUSIONS
  The approach to diagnosis, investigation and management of CUP by medical oncologists in Australia is variable. Many preferred to estimate the primary site and treat accordingly. Pharmaceutical Benefits Schedule restrictions may encourage the practice of 'best guessing'.
authors.affiliation: Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: Christos S
authors.initials: CS
authors.lastname: Karapetis
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Guccione
authors.affiliation: Sydney Medical School and Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
authors.forename: Martin H N
authors.initials: MH
authors.lastname: Tattersall
authors.affiliation: Cancer Australia, Sydney, New South Wales, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Gooden
authors.affiliation: Cancer Epidemiology Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Vajdic
authors.affiliation: Ingram School of Nursing, St Mary's Research Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lambert
authors.affiliation: School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.|Faculty of Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Monica
authors.initials: M
authors.lastname: Robotin
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.affiliation: Department of Psychological Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia.
authors.forename: Penelope
authors.initials: P
authors.lastname: Schofield
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003142:Communication; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis*; D000072103:Oncologists / Q000592:standards; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: 
  CUP
  ; cancer of unknown primary; communication; diagnosis; language; survey