Perceptions of prognosis, treatment, and treatment impact on prognosis in non-small cell lung cancer

Study objectives: We designed and performed a survey to assess the roles and knowledge level of physicians, by specialty, in the management of non- small cell lung cancer (NSCLC). The primary objective was to evaluate the potential variability of physician perceptions of prognosis, recommended treatments, and the impact of treatment on prognosis for each stage of NSCLC. Design: A random national sample of physicians from one of five specialties (primary care, pulmonary medicine, medical oncology, radiation oncology, or thoracic surgery) were invited to complete a 15-min questionnaire. Five case scenarios were presented, each representing a different stage of NSCLC. Participants were asked to state the expected prognosis, recommended treatment, and expected impact of the recommended treatment on prognosis for each scenario. Measurements and results: Of the 442 physicians contacted, 350 completed the survey (86% response rate). In general, physicians agreed that the primary treatment of patients with stage I disease should be surgery. For all other stages of disease, however, there was a wide range of opinion regarding the treatment of choice and expected impact of treatment on prognosis. In particular, a significant proportion of physicians recommended only supportive care for patients with stage IV disease, despite demonstrated benefits of chemotherapy. Conclusions: Physicians from differing specialties have varied opinions on the management of NSCLC, particularly stages II to IV. Education regarding state-of-the-art therapy should be directed not only at traditional audiences (ie, medical oncologists) but also the major physician specialties involved in the care of NSCLC patients. Wider implementation of treatment advances in late-stage disease could significantly increase the numbers of patients living for a longer time.