Treatment decisions
The authors noted regimens were often used in first-line treatment even when phase III data hadn’t been published, indicating that oncologists are comfortable making therapeutic choices based on preliminary or phase II data. However, Dr. Zafar’s group also found that the reason why a physician chose a particular regimen was not well documented and, in fact, was missing from the majority (65%) of the medical records reviewed for this study. In those rare instances when treatment options were noted, 12% of the oncologists said they made a decision on the basis of perceived patient tolerability, while 10% cited treatment guidelines.
In an interview with Oncology News International, Dr. Zafar offered some thoughts on why the information was not documented. “The lack of documentation is more likely due to the complexity of the decision-making process and the time involved in appropriately documenting the process,” he said. “For example, the FOLFIRI regimen might be chosen over the FOLFOX regimen because the patient is an auto mechanic and his work would suffer from the inevitable neuropathy associated with FOLFOX.”
On the other hand, the reasons for ending therapy were documented and they included disease progression (29%) and tolerability or toxicity (18%). For instance, when choosing between an irinotecan-based regimen and an oxaliplatin-based regimen, oncologists may be more comfortable with the perceived toxicity profile of the latter, the authors wrote.
Finally, patient age played an important part in the delivery of chemotherapy. The authors pointed out that previously published research supports an age bias for older patients, even though these patients generally do as well as their younger counterparts. Dr. Zafar said that he believes this bias will diminish with the general graying of the population.
“As oncologists become more accustomed to treating older patients, and as older patients are enrolled in clinical trials, I think the age bias will lessen. The key to shrinking the age bias lies in greater enrollment and eligibility of older patients in clinical trials such that the data produced by trials are more representative of the general cancer population,” he said.
Dr. Zafar and colleagues are currently enrolling patients in a study to understand treatment-related decision making from the patient’s perspective. Also, Dr. Zafar is an investigator with the Cancer Care Outcomes Research & Surveillance Consortium (CanCORS), a National Cancer Institute-funded, prospective, multi-health system study designed to measure the quality of cancer care and associated health outcomes in the U.S.
