Dataset Information

De-escalated administration of bone-targeted agents in patients with breast and prostate cancer-A survey of Canadian oncologists.

ABSTRACT:

Objective

Questions remain regarding the optimal use of bone-targeted agents in patients with metastatic bone disease. The purpose of this study was to assess current clinical practice regarding the use and administration of bone-targeted agents by Canadian oncologists in patients with metastatic breast and prostate cancer.

Methods

A survey was designed to explore; bone-targeted agent use in metastatic bone disease, variability in the choice and the frequency of administration of these agents. Opinions were sought on potential outcomes for future trials.

Results

A total of 193 clinicians were contacted and 90 completed our survey (response rate 49% after adjustment for inactivity). Survey respondents were medical oncologists (71.1%), radiation oncologists (21.1%) and urologists (7.8%). The findings suggest that once bone-targeted agents are started they are rarely discontinued. More agents are used in breast cancer than in prostate cancer. There was considerable interest in performing studies of de-escalated therapy in both breast and prostate cancer. Physicians requested (86%) that the primary study endpoint be the occurrence of skeletal related events and not biomarker driven.

Conclusions

Despite clinical practice guidelines and widespread use, significant areas of clinical equipoise with respect to use of bone-targeted agents exist. Findings from this survey suggest that physicians are interested in de-escalated therapy for both breast and prostate patients. However, the use of multiple agents in breast cancer and the desire for skeletal related events to be the primary endpoint means that very large randomized studies will be required.

SUBMITTER: Hutton B

PROVIDER: S-EPMC4723366 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Publications

De-escalated administration of bone-targeted agents in patients with breast and prostate cancer-A survey of Canadian oncologists.

Hutton Brian B Addison Christina C Mazzarello Sasha S Joy Anil A AA Bouganim Nathaniel N Fergusson Dean D Clemons Mark M

Journal of bone oncology 20130415 2

<h4>Objective</h4>Questions remain regarding the optimal use of bone-targeted agents in patients with metastatic bone disease. The purpose of this study was to assess current clinical practice regarding the use and administration of bone-targeted agents by Canadian oncologists in patients with metastatic breast and prostate cancer.<h4>Methods</h4>A survey was designed to explore; bone-targeted agent use in metastatic bone disease, variability in the choice and the frequency of administration of ...[more]

PMID: 26909274

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Project description:BackgroundIn June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient characteristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid.MethodsWe developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March-June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis.ResultsThe survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slightly more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress.ConclusionsIn this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at the end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.

Dataset Information

De-escalated administration of bone-targeted agents in patients with breast and prostate cancer-A survey of Canadian oncologists.

Objective

Methods

Results

Conclusions

Publications

De-escalated administration of bone-targeted agents in patients with breast and prostate cancer-A survey of Canadian oncologists.

Similar Datasets

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