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

ABSTRACT

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.