Identification of Educational Gaps Among Oncologists Who Manage Patients with Pancreatic Cancer.

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDA) is associated with poor outcomes and presents oncologists with a myriad of clinical challenges. This study was conducted to assess oncologists' practice patterns and to identify the greatest areas of need for future PDA continuing medical education (CME) programs. METHODS: Case vignettes have been validated as an effective tool to assess how physicians approach and treat a wide array of diseases. In order to assess practice patterns for resectable, locally advanced unresectable, and metastatic PDA, an online case vignette survey was distributed to practicing medical oncologists. RESULTS: Responses from 150 US-practicing oncologists were analyzed, and several key opportunities for future CME programs were identified. For case 1 (patient with resectable PDA), 44% of oncologists did not select an evidence-based adjuvant chemotherapy regimen. For case 2 (patient with locally advanced PDA who develops metastases and neuropathy after first-line nab-paclitaxel/gemcitabine followed by chemoradiation), 57% of oncologists did not select an evidence-based second-line chemotherapy regimen, and 35% selected a regimen containing oxaliplatin, a chemotherapeutic known to cause neuropathy. For case 3 (patient with a pancreatic mass and liver metastases), only 34% of oncologists recommended a biopsy, chest imaging, and liver function tests which should be standard of care assessments with this presentation. For all three cases, clinical trial referral was selected by fewer than 5% of respondents. CONCLUSIONS: This study identified appreciable discrepancies between oncologists' recommendations and standard evidence-based guidelines. Well-designed CME programs may help to bridge the educational gaps identified and improve adherence to practice guidelines.

Pancreatic Cancer Management and Treatment Landscape Awareness of Gastroenterologists: Results from US Physician Surveys Conducted in 2013 and 2015.

INTRODUCTION: In the US, gastroenterologists (GIs) often inform patients of the initial diagnosis of pancreatic cancer. Thus, GIs are frequently the first physicians to provide vital information regarding treatment strategies and options to patients which can have significant impact on subsequent clinical decision-making. Since treatments for pancreatic cancer are rapidly evolving, it may be challenging for GIs to maintain an adequate knowledge base required to provide accurate cursory information or avoid providing inaccurate data to patients at a very sensitive point in time in their care. However, little to no published data are available on the treatment awareness, knowledge, and comfort of GIs in the United States who diagnose pancreatic cancer. METHODS: This study evaluated the self-reported management of pancreatic cancer, including patient discussion, familiarity with treatments, and use of guidelines. A survey was developed and fielded to US academic and community GIs in 2013. In 2015, the survey was redistributed as a follow-up to determine whether familiarity and practice has shifted; two questions were added, all other items remained identical. For the 2013 sample, 432 GIs were contacted and 113 valid responses were collected (26.2). For the 2015 sample, 712 GIs were contacted and 126 valid responses were collected (17.7%). Analysis compared differences between academic and community gastroenterologists and gastroenterologists performing endoscopic ultrasound (EUS) versus those that do not. RESULTS: Self-reported familiarity with pancreatic cancer therapies has not significantly increased from 2013 to 2015, as gastroenterologists report highest familiarity with 5-fluorouracil and gemcitabine. In the 2015 sample, 68% of academic and 58% of community gastroenterologists entered gemcitabine when identifying therapies FDA-approved for treatment of pancreatic cancer. However, 16% of academic and 24% of community gastroenterologists indicated that they were unaware of which therapies are approved, and some indicated therapies that are not FDA-approved for the treatment of pancreatic cancer, such as capecitabine (10%) and paclitaxel (7%). Gastroenterologists in 2015 are significantly more likely than in 2013 to discuss clinical trial enrollment with their patients with metastatic pancreatic cancer (5.5 on a 10-point scale vs 4.2, P = .013) but were not more confident in their ability to conduct such discussions. When managing patients with pancreatic cancer, academic, and community gastroenterologists responded that they were most likely to refer to guidelines developed by their professional organizations, such as the AGA and ACG. However, these groups have not developed specific guidelines for the management of patients with pancreatic cancer. CONCLUSIONS: As gastroenterologists are frequently the first physicians to disclose a diagnosis of pancreatic cancer, education is needed to improve familiarity with current available treatments, clinical trials, and emerging therapies and resources to advise their patients.

Current pathology practices in and barriers to MDS diagnosis.

Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic stem cell malignancies that represent a diagnostic challenge for pathologists. Accurate classification and prognostic scoring are essential to treating MDS. To understand factors that affect MDS management, a case-based survey was distributed to hematopathologists (n=53) and general pathologists (n=72) to identify perceived barriers, attitudes, and practices in MDS diagnosis. Results demonstrated confidence and practice gaps. Only 33% of general pathologists are confident in diagnosing MDS. Neither general pathologists nor hematopathologists are comfortable using the International Prognostic Scoring System to characterize risk. Thirty percent of general pathologists and 22% of hematopathologists would not include bone marrow aspirate and cytogenetics in initial testing of a neutropenic patient. Most practitioners tested appropriately for disease classification and prognosis; discrepancies were identified in testing to differentiate MDS from acute myeloid leukemia and testing in post treatment specimens. These results have implications in the management of MDS.