Schroen A T, Detterbeck F C, Crawford R, Rivera M P, Socinski M A
Robert Wood Johnson Clinical Scholars Program, University of North Carolina, Chapel Hill, NC, USA.
Chest. 2000 Jul;118(1):129-37. doi: 10.1378/chest.118.1.129.
The physicians who initially evaluate patients with non-small cell lung cancer (NSCLC) strongly impact the course of therapy. Their beliefs in treatment and prognosis may contribute to practices of variable quality and appropriateness. We sought to better describe beliefs among pulmonologists and thoracic surgeons who were selected for guiding early therapy and referrals in patients with NSCLC.
Mail questionnaire focusing on survival estimates, treatment perceptions, and referral patterns.
Twelve hundred pulmonologists and 800 thoracic surgeons who were clinically active members of the American College of Chest Physicians.
Response rates of 50% for pulmonologists and 52% for thoracic surgeons were obtained after two mailings. Five-year survival estimates for patients with resected stage I NSCLC revealed that 30% of respondents overestimated survival rates and 18% underestimated survival rates. The underestimation of survival rate was found among more respondents who are practicing pulmonology than thoracic surgery (22% vs 10% [corrected], respectively), who were trained before 1980 than after 1980 (29% vs 10% [corrected], respectively), and who were seeing < 10 lung cancer patients annually than those who were seeing > 25 (31% vs 0.14%, respectively). Beliefs in the survival benefit of adjuvant chemotherapy or of radiation in stage I-IIIA disease divided respondents within both specialties. Chemotherapy plus radiation vs radiation alone in unresectable stage IIIA-B NSCLC was viewed as benefiting survival less often by physicians seeing < 10 lung cancer patients annually rather than > 25 (57% vs 77% [corrected], respectively) and by physicians underestimating rather than correctly estimating survival in early-stage disease (58% vs 72% [corrected], respectively). Chemotherapy was believed to confer survival benefits in patients with stage IV disease by one third of respondents.
Certain physician characteristics, particularly the length of time since training and NSCLC patient volume, are associated with beliefs not conclusively supported in the medical literature or with opinions inconsistent within and between specialties.
最初评估非小细胞肺癌（NSCLC）患者的医生对治疗过程有重大影响。他们对治疗和预后的看法可能导致质量和适宜性各异的医疗行为。我们试图更好地描述被挑选出来指导NSCLC患者早期治疗和转诊的肺科医生和胸外科医生的看法。
邮寄调查问卷，重点关注生存估计、治疗认知和转诊模式。
1200名肺科医生和800名胸外科医生，他们均为美国胸科医师学会的临床活跃会员。
经过两次邮寄，肺科医生的回复率为50%，胸外科医生的回复率为52%。对于接受手术切除的I期NSCLC患者的五年生存估计显示，30%的受访者高估了生存率，18%的受访者低估了生存率。与胸外科医生相比，更多从事肺科的受访者低估了生存率（分别为22%和10%[校正后]）；与1980年后接受培训的医生相比，1980年前接受培训的医生低估生存率的比例更高（分别为29%和10%[校正后]）；与每年诊治超过25例肺癌患者的医生相比，每年诊治少于10例肺癌患者的医生低估生存率的比例更高（分别为31%和0.14%）。对于I-IIIA期疾病辅助化疗或放疗对生存的益处，两个专业领域的受访者看法不一。对于不可切除的IIIA-B期NSCLC患者，与每年诊治超过25例肺癌患者的医生相比，每年诊治少于10例肺癌患者的医生认为化疗加放疗与单纯放疗相比对生存有益的比例更低（分别为57%和77%[校正后]）；与正确估计早期疾病生存率的医生相比，低估早期疾病生存率的医生认为化疗加放疗与单纯放疗相比对生存有益的比例更低（分别为58%和72%[校正后]）。三分之一的受访者认为化疗能使IV期疾病患者受益。
某些医生特征，特别是培训后的时间长度和NSCLC患者数量，与医学文献中未得到确凿支持的看法或专业领域内及专业领域间不一致的观点有关。
