FRENCH PHYSICIANS ATTITUDE TOWARDS RECTAL-CARCINOMA

Objectives. - Improvements in treatment of rectal cancer have enabled a better control of locoregional disease. Our objective was to describ e the therapeutic decisions of different specialists implied through c linical cases and the influence of their professional characteristics. Methods, - In spring 1996 a questionnaire was mailed to a random samp le of 621 French physicians, presenting 3 clinical cases of rectal can cer at different stages, The present analysis deals with a clinical ca se concerning a 46 year-old man bearing a T3N0 tumor, at 7 cm from the anal verge. Statistical analysis (uni and multivariate, by logistic r egression) was performed with SPSS software. Results. - Three hundred fifty two exploitable responses were returned (response rate : 57 %). Half of the physicians chose a pluridisciplinary decision modality. Th ere were differences according to the speciality (P < 0.003), to the t ype of practice (public/private) (P < 10(-4)) and to the proximity of specialized units (P = 0.03). Therapeutic attitudes consisted in a com bination of radiotherapy and surgery (RT-SU) for 95 % of the physician s. The therapeutic choice was in agreement with the French consensus c onference for 71 % of physicians. Two main attitudes emerged for this clinical case: exclusive RT-SU combination (43.5 %) and RT-SU with opt ional or systematic chemotherapy (CT) (52 %). The latter choice appear ed to be closely dependent on medical speciality (P = 0.0004) and back ground (P = 0.002). Conclusion. - Decision making is mainly related to the place of work, whereas the therapeutic attitude depends on physic ians' own characteristics. Until 1990, multiple therapeutic options fo r rectal cancer were performed in France. Nowadays, for a T3N0 tumor, the argumentation is rather focused on the indication of CT combined w ith the standard RT-SU treatment. Results from ongoing controlled stud ies will help update consensual recommendations.