Transcript NCRI 2012 clinician poster - SHORE-C

Oncologists’ Views about the Treatments and Care Associated
with Advanced
varian Cancer
1
1
2
3
2
1
1
1
Jenkins V , Banerjee S , Ledermann J , Gore M , Catt S , Monson K , Fallowfield L
2
3
SHORE-C University of Sussex, The Royal Marsden NHS Foundation Trust London, University College London
Background
The management of ovarian cancer (OC) involves a multidisciplinary approach and depends on factors including histological
subtype, grade, stage of the cancer and performance status. Treatment is essentially palliative and aims to reduce the
symptoms of disease without creating too many extra burdens and iatrogenic harms. Surgery together with 1 st & 2nd line
chemotherapy is standard practice, but there are few published data on the variations in practice across the UK.
Method
Online survey between October & December 2011 to canvass opinions from UK oncologists about their management of
women with advanced OC. This survey was carried out prior to the Cancer Drugs Fund decision about bevacizumab.
The survey has 5 sections:1. Demographics: plus perceptions of most troubling presenting symptoms for OC
2. Routine NHS care (Non Trial Patients): 1st, 2nd line treatments & subsequent therapies
3. Maintenance therapy: plus opinions about minimum gain required for PFS and OS
4. Clinical trial participation
5. Supportive care
Additionally, we are interviewing 200 patients about their experiences of treatment and management of their disease in the
ADV CATE study (Advanced Ovarian Cancer: Care & Treatment Experiences). See Poster # B142
Results: Section 1: Demographics
N (66)
Sex
male/female
medical/clinical oncologist
NHS Trust clinician/University clinical academic
NHS alone/NHS & Private
number of advanced OC patients treated per year?
<30
31-60
>60
33/33
44/22
54/11
36/30
14
27
25
Months →
What minimum gain in PFS would
make YOU feel it worthwhile to
offer maintenance therapy? (n=50)
What minimum gain in OS would
make YOU feel it worthwhile to
offer maintenance therapy? (n=60)
6
Bloating
Question ▼
What do you think YOUR PATIENT
would consider worthwhile? (n=50)
Perceptions as to symptoms patients
most troubled by at presentation
Lethargy
Section 3: Maintenance therapy
If available would you offer maintenance therapy based on:• Progression Free Survival (PFS): 50/60 (83%)Yes
• Overall Survival (OS): 60/60 (100%) Yes
29
Abdo swelling
32
Abdo pain
What do you think YOUR PATIENT
would consider worthwhile? (n=60)
33
1-2
3-4
5-6
7+
0
19
24
7
12
26
9
3
2
36
15
7
25
23
5
7
%
Section 4: Clinical trial participation
59/60 (98%) clinicians active in clinical trials
21/59 (36%) conduct early phase trials
29/32 (91%) refer 1-4 patients per year for early phase trials
Section 2: Routine NHS care (non-trial)
• 63/65 (97%) conducted regular follow up clinics
• 43/66 (65%) measured routine CA125 blood levels
“Which agents do you most commonly use in routine
NHS care?”
carboplatin with paclitaxel 56/66 (85%)
Rank Main triggers for change in management of
Order 1st line treatment
%
1st
symptomatic disease progression
74%
2nd
severe side effects of current treatment
41%
3rd
deterioration in quality of life
46%
4th
non-symptomatic disease progression shown by
test results
49%
Rank ordered as 1st choice in 2nd line & subsequent
treatments for patients who are:-
%
platinum sensitive
carboplatin + paclitaxel
63%
partially platinum
sensitive
carboplatin with paclitaxel 3
weekly
40%
platinum resistant
liposomal doxorubicin
68%
Section 5: Supportive care :
Most recommended support/information sources
Personnel
CNS
(98%)
cancer info centre
(93%)
dietician
(87%)
Written
Macmillan
(100%)
In house leaflets
(73%)
Ovacome
(28%)
Websites
Macmillan
(91%)
Ovacome
(43%)
Cancer help
(42%)
Summary:
• Treatment for OC across UK varies and main triggers for
change in management are also inconsistent
• Not all routinely measure CA125 at follow up
• Doctors’ perceptions of benefits they think worthwhile
differ from those they believe their patients hold
• Supportive interventions for worst symptoms of disease
and treatment side effects are needed
Acknowledgement: Roche UK unrestricted educational grant.