DOES KNOWLEDGE GUIDE PRACTICE - ANOTHER LOOK AT THE MANAGEMENT OF NON-SMALL-CELL LUNG-CANCER

Purpose: To describe Canadian doctors' beliefs about the appropriate r ole of chemotherapy and radiotherapy in the management of non-small-ce ll lung cancer (NSCLC). Methods: A mail survey of a random sample of C anadian respirologists, thoracic surgeons, radiation oncologists, and medical oncologists was performed. Three cases of NSCLC were described and respondents were asked to estimate the prognosis in each case and to give their treatment recommendations. Results: Responses were obta ined from 234 of 330 eligible subjects (74%). Doctors' treatment recom mendations varied widely. After a complete resection for stage II NSCL C, 68% recommended no adjuvant treatment, 28%. recommended radiotherap y, 1% recommended chemotherapy, and 39% recommended both radiotherapy and chemotherapy. For an asymptomatic patient with stage IIIb NSCLC, 1 7% recommended no active treatment, 65% recommended radiotherapy alone , 16% recommended radiation and chemotherapy, and 2% recommended chemo therapy alone. For an asymptomatic patient with a stage IV NSCLC, 80% recommended no active treatment and 20% recommended chemotherapy, Doct ors' beliefs about the natural history of NSCLC and its response to tr eatment varied widely, Seventy-five percent of respondents believed th at adjuvant radiotherapy did not increase survival in stage II disease , but 25% believed that it did. Thirty percent believed that the addit ion of chemotherapy to radiotherapy in stage III increased survival, b ut 70% believed that it did not. Fifty-five percent believed that chem otherapy increased the median survival in stage IV, but 45% believed t hat it did not. Doctors' beliefs about the efficacy of treatment were strongly associated with their treatment recommendations. Conclusion: Personal beliefs, rather than universal knowledge, currently guide the management of NSCLC in Canada. J Clin Oncol 13:1904-1911. (C) 1995 by American Society of Clinical Oncology.