Cyclophosphamide in the treatment of pulmonary diseases - Survey of use, training, and practitioner knowledge base

Objective: To assess pulmonologists' use, training in the use, and knowledg e base of the drug cyclophosphamide. Design: Survey through questionnaire. Testing of knowledge base before and after instructional conference. Participants and methods: Pulmonologists (94 attendings, 31 fellows), selec ted randomly at the 1996 and 1997 annual meetings of The American Thoracic Society, completed surveys of their use and training in the use of cyclopho sphamide. Thirty-five attending at the 1998 meeting completed a test of kno wledge base of the drug. Members of the pulmonary teaching service at The U niversity of Chicago Hospitals completed the test before and after a case-b ased conference designed to educate pulmonologists in the use of the drug. Results: Forty-three percent of the attending pulmonologists and 55% of the fellows were currently using the drug in the management of their patients; 77% of the attending pulmonologists had prescribed the drug in the past. N onmalignant diseases for which the drug was prescribed included usual inter stitial pneumonitis/desquamative interstitial pneumonitis, vasculitis, coll agen vascular disease, constrictive bronchiolitis, sarcoid, and Goodpasture 's disease. Sixty-eight percent of attending pulmonologists and 81% of fell ows had no training in the drug's use. Of the attending pulmonologists who made use of the drug, 64% were prescribing and managing its use themselves. Of those who prescribed and managed the drug's use themselves, 65% had had no training in its use. Of those fellows who prescribed and managed the dr ug's use themselves, 73% had had no training in the drug's use. On knowledg e-based testing, the average correct score was 30 +/- 10%. With an educatio nal conference, average pre- and post-test scores rose from 40 +/- 10% to 8 0 coproduct 10% (p < 0.001), Conclusion: Cyclophosphamide had been used by the vast majority of pulmonol ogists, either currently or in the past, for a wide variety of lung disease s. Its use is commonly managed by physicians who have no specific training relevant to this agent. Practitioner knowledge base of the drug is poor, an d case-based conferences in fellowship may be an effective means of imparti ng information concerning: this drug.