Oncologists’ Views about the Treatments and Care Associated with Advanced varian Cancer

Jenkins V1, Banerjee S2 , Ledermann J3 , Gore M2, Catt S1, Monson K1, Fallowfield L1

1SHORE-C University of Sussex, 2The Royal Marsden NHS Foundation Trust London, 3 University College London

BackgroundThe 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 1st & 2nd line chemotherapy is standard practice, but there are few published data on the variations in practice across the UK. MethodOnline 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:-•Demographics: plus perceptions of most troubling presenting symptoms for OC•Routine NHS care (Non Trial Patients): 1st, 2nd line treatments & subsequent therapies•Maintenance therapy: plus opinions about minimum gain required for PFS and OS•Clinical trial participation•Supportive careAdditionally, 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

Acknowledgement: Roche UK unrestricted educational grant.

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%)

Results: Section 1: Demographics N (66)Sexmale/female 33/33

medical/clinical oncologist 44/22

NHS Trust clinician/University clinical academic 54/11

NHS alone/NHS & Private 36/30

number of advanced OC patients treated per year?

<30 31-60 >60

142725

Section 3: Maintenance therapyIf available would you offer maintenance therapy based on:-

•Progression Free Survival (PFS): 50/60 (83%)Yes•Overall Survival (OS): 60/60 (100%) Yes

Question ▼ Months → 1-2 3-4 5-6 7+

What minimum gain in PFS would make YOU feel it worthwhile to offer maintenance therapy? (n=50)

0 19 24 7

What do you think YOUR PATIENT would consider worthwhile? (n=50)

12 26 9 3

What minimum gain in OS would make YOU feel it worthwhile to offer maintenance therapy? (n=60)

2 36 15 7

What do you think YOUR PATIENT would consider worthwhile? (n=60)

25 23 5 7

Section 4: Clinical trial participation59/60 (98%) clinicians active in clinical trials 21/59 (36%) conduct early phase trials29/32 (91%) refer 1-4 patients per year for early phase trials

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

Rank Order

Main triggers for change in management of 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%)

33

32

29

6

Abdo pain

Abdo swelling

Bloating

Lethargy

Perceptions as to symptoms patientsmost troubled by at presentation

%