Variations in oncologist recommendations for chemotherapy for stage IV lung cancer

What is the role of performance status?

Diana Tisnado, Jennifer Malin, Katherine Kahn, Mary Beth Landrum, Robert Fletcher, Carrie Klabunde, Steven Clauser, Selwyn O. Rogers, Nancy L. Keating

    Research output: Contribution to journalArticle

    2 Citations (Scopus)

    Abstract

    Purpose: Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. Methods: We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. Results: Nearly all physicians (adjusted rate, 97% to 99%) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38% to 53%) recommended chemotherapy for patients with poor performance status (P <.001). Compared with patient factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. Conclusion: Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care.

    Original languageEnglish (US)
    Pages (from-to)653-662
    Number of pages10
    JournalJournal of Oncology Practice
    Volume12
    Issue number7
    DOIs
    StatePublished - Jul 1 2016

    Fingerprint

    Lung Neoplasms
    Drug Therapy
    Physicians
    Non-Small Cell Lung Carcinoma
    Oncologists
    Motivation
    Consensus
    Logistic Models
    Demography
    Outcome Assessment (Health Care)
    Survival

    ASJC Scopus subject areas

    • Oncology
    • Oncology(nursing)
    • Health Policy

    Cite this

    Variations in oncologist recommendations for chemotherapy for stage IV lung cancer : What is the role of performance status? / Tisnado, Diana; Malin, Jennifer; Kahn, Katherine; Landrum, Mary Beth; Fletcher, Robert; Klabunde, Carrie; Clauser, Steven; Rogers, Selwyn O.; Keating, Nancy L.

    In: Journal of Oncology Practice, Vol. 12, No. 7, 01.07.2016, p. 653-662.

    Research output: Contribution to journalArticle

    Tisnado, D, Malin, J, Kahn, K, Landrum, MB, Fletcher, R, Klabunde, C, Clauser, S, Rogers, SO & Keating, NL 2016, 'Variations in oncologist recommendations for chemotherapy for stage IV lung cancer: What is the role of performance status?', Journal of Oncology Practice, vol. 12, no. 7, pp. 653-662. https://doi.org/10.1200/JOP.2015.008425
    Tisnado, Diana ; Malin, Jennifer ; Kahn, Katherine ; Landrum, Mary Beth ; Fletcher, Robert ; Klabunde, Carrie ; Clauser, Steven ; Rogers, Selwyn O. ; Keating, Nancy L. / Variations in oncologist recommendations for chemotherapy for stage IV lung cancer : What is the role of performance status?. In: Journal of Oncology Practice. 2016 ; Vol. 12, No. 7. pp. 653-662.
    @article{646f678b3a9843cab6de30b3ce98e56a,
    title = "Variations in oncologist recommendations for chemotherapy for stage IV lung cancer: What is the role of performance status?",
    abstract = "Purpose: Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. Methods: We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. Results: Nearly all physicians (adjusted rate, 97{\%} to 99{\%}) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38{\%} to 53{\%}) recommended chemotherapy for patients with poor performance status (P <.001). Compared with patient factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. Conclusion: Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care.",
    author = "Diana Tisnado and Jennifer Malin and Katherine Kahn and Landrum, {Mary Beth} and Robert Fletcher and Carrie Klabunde and Steven Clauser and Rogers, {Selwyn O.} and Keating, {Nancy L.}",
    year = "2016",
    month = "7",
    day = "1",
    doi = "10.1200/JOP.2015.008425",
    language = "English (US)",
    volume = "12",
    pages = "653--662",
    journal = "Journal of Oncology Practice",
    issn = "1554-7477",
    publisher = "American Society of Clinical Oncology",
    number = "7",

    }

    TY - JOUR

    T1 - Variations in oncologist recommendations for chemotherapy for stage IV lung cancer

    T2 - What is the role of performance status?

    AU - Tisnado, Diana

    AU - Malin, Jennifer

    AU - Kahn, Katherine

    AU - Landrum, Mary Beth

    AU - Fletcher, Robert

    AU - Klabunde, Carrie

    AU - Clauser, Steven

    AU - Rogers, Selwyn O.

    AU - Keating, Nancy L.

    PY - 2016/7/1

    Y1 - 2016/7/1

    N2 - Purpose: Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. Methods: We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. Results: Nearly all physicians (adjusted rate, 97% to 99%) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38% to 53%) recommended chemotherapy for patients with poor performance status (P <.001). Compared with patient factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. Conclusion: Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care.

    AB - Purpose: Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. Methods: We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study. Physicians were queried about their likelihood to recommend chemotherapy to patients with stage IV lung cancer with varying performance status (Eastern Cooperative Oncology Group performance status 0 [good] v 3 [poor]) and presence or absence of tumor-related pain. Repeated measures logistic regression was used to estimate the independent associations of patients' performance status and symptoms and physicians' demographic and practice characteristics with chemotherapy recommendations. Results: Nearly all physicians (adjusted rate, 97% to 99%) recommended chemotherapy for patients with good performance status, and approximately half (adjusted rate, 38% to 53%) recommended chemotherapy for patients with poor performance status (P <.001). Compared with patient factors, physician and practice characteristics were less strongly associated with chemotherapy recommendations in adjusted analyses. Conclusion: Strong consensus among oncologists exists for chemotherapy in patients with advanced non-small-cell lung cancer and good performance status. However, the relatively high rate of chemotherapy recommendations for patients with poor performance status despite the unfavorable risk-benefit profile highlights the need for ongoing work to define high-value care in oncology and to implement and evaluate strategies to align incentives for such care.

    UR - http://www.scopus.com/inward/record.url?scp=84978835965&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84978835965&partnerID=8YFLogxK

    U2 - 10.1200/JOP.2015.008425

    DO - 10.1200/JOP.2015.008425

    M3 - Article

    VL - 12

    SP - 653

    EP - 662

    JO - Journal of Oncology Practice

    JF - Journal of Oncology Practice

    SN - 1554-7477

    IS - 7

    ER -