Au Lewis, Turner Natalie, Wong Hui-Li, Field Kathryn, Lee Belinda, Boadle David, Cooray Prasad, Karikios Deme, Kosmider Suzanne, Lipton Lara, Nott Louise, Parente Phillip, Tie Jeanne, Tran Ben, Wong Rachel, Yip Desmond, Shapiro Jeremy, Gibbs Peter
Department of Medical Oncology, Western Hospital, Melbourne, Australia.
Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
Asia Pac J Clin Oncol. 2018 Apr;14(2):e167-e174. doi: 10.1111/ajco.12671. Epub 2017 Mar 16.
Current efforts to understand patient management in clinical practice are largely based on clinician surveys with uncertain reliability. The TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) database is a multisite registry collecting comprehensive treatment and outcome data on consecutive metastatic colorectal cancer (mCRC) patients at multiple sites across Australia. This study aims to determine the accuracy of oncologists' impressions of real-word practice by comparing clinicians' estimates to data captured by TRACC.
Nineteen medical oncologists from nine hospitals contributing data to TRACC completed a 34-question survey regarding their impression of the management and outcomes of mCRC at their own practice and other hospitals contributing to the database. Responses were then compared with TRACC data to determine how closely their impressions reflected actual practice.
Data on 1300 patients with mCRC were available. Median clinician estimated frequency of KRAS testing within 6 months of diagnosis was 80% (range: 20-100%); the TRACC documented rate was 43%. Clinicians generally overestimated the rates of first-line treatment, particularly in patients over 75 years. Estimate for bevacizumab in first line was 60% (35-80%) versus 49% in TRACC. Estimated rate for liver resection varied substantially (5-35%), and the estimated median (27%) was inconsistent with the TRACC rate (12%). Oncologists generally felt their practice was similar to other hospitals.
Oncologists' estimates of current clinical practice varied and were discordant with the TRACC database, often with a tendency to overestimate interventions. Clinician surveys alone do not reliably capture contemporary clinical practices in mCRC.
目前在临床实践中理解患者管理的努力主要基于可靠性不确定的临床医生调查。TRACC（复发性和晚期结直肠癌治疗）数据库是一个多中心登记处，收集了澳大利亚多个地点连续转移性结直肠癌（mCRC）患者的综合治疗和结局数据。本研究旨在通过比较临床医生的估计与TRACC收集的数据，确定肿瘤学家对实际临床实践印象的准确性。
来自9家向TRACC贡献数据的医院的19名医学肿瘤学家完成了一项包含34个问题的调查，内容涉及他们对自己所在机构以及向该数据库贡献数据的其他医院中mCRC管理和结局的印象。然后将回答与TRACC数据进行比较，以确定他们的印象与实际临床实践的符合程度。
有1300例mCRC患者的数据可用。临床医生估计诊断后6个月内KRAS检测的中位频率为80%（范围：20%-100%）；TRACC记录的比例为43%。临床医生普遍高估了一线治疗的比例，尤其是75岁以上的患者。一线使用贝伐单抗的估计比例为60%（35%-80%），而TRACC中的比例为49%。肝切除的估计比例差异很大（5%-35%），估计中位数（27%）与TRACC比例（12%）不一致。肿瘤学家普遍认为他们的临床实践与其他医院相似。
肿瘤学家对当前临床实践的估计各不相同，且与TRACC数据库不一致，通常有高估干预措施的倾向。仅靠临床医生调查不能可靠地反映mCRC的当代临床实践。
