Patterns of practice survey for nonsmall cell lung carcinoma in the US

BACKGROUND, Nonsmall cell lung carcinoma comprises approximately 75% of all lung carcinoma cases in the U.S. Newly evolving strategies have created co nsiderable controversy regarding the optimal treatment for patients diagnos ed with this disease. METHODS. A 17-item survey was designed to collect demographic data and info rmation regarding practice patterns for nonsmall cell lung carcinoma, inclu ding patient assessment, treatment approaches, and roles of chemotherapy an d radiotherapy. Surveys were mailed in the summer of 1997 to approximately 9200 oncologists of all types throughout the U.S. Practice settings include d private office, private hospital, academic, university-affiliated office, government, and Veterans Administration institutions. RESULTS. Approximately 10% of the oncologists responded (n = 979), includin g 499 medical oncologists (51%), 464 radiation oncologists (47%), and 16 ot hers (2%). For the adjuvant treatment of surgically resected N1-2 disease, combined modality treatment was preferred over radiation therapy alone by m edical oncologists (48% vs. 16%; P < 0.001) and radiation therapy alone was preferred over combined modality treatment by radiation oncologists (55% v s. 38%; P < 0.001). The combination of paclitaxel and carboplatin was the p referred first-line regimen for all stages of nonsmall cell lung carcinoma by the majority of medical oncologists (55%), whereas the majority of radia tion oncologists (58%) chose the combination of etoposide and platinum. Wit h regard to the optimal combined modality approach, respondents were divide d evenly between concurrent chemoradiotherapy (34%) and sequential chemorad iotherapy (31%). Overall, respondents reported basing treatment decisions l argely on published literature (55%) compared with personal experience (19% ), seminars and colleagues (16%), and clinical trial availability (10%) (P < 0.001). CONCLUSIONS, This survey confirms many differences in practice patterns amo ng medical oncologists and radiation oncologists in the treatment of patien ts with nonsmall cell lung carcinoma and suggests the need for the multidis ciplinary management of this entity. In addition, the current study demonst rates that reliance on the medical literature as a basis for treatment stea dily declines the longer the physician has been in practice. Cancer 2000;88 :1336-1346, (C) 2000 American Cancer Society.