Challenges in the Understanding of Oligometastatic Disease in Clinical Practice

Introduction: There is little data describing oligometastatic disease (OMD) and decision-making. We sought to understand the knowledge gaps and challenges in deciphering and delivering treatments.

This is a quality improvement (QI) study conducted via an anonymous survey. Three different clinical scenarios of OMD (oligo-recurrence disease, synchronous de-novo OMD, and oligo-progressive disease) were presented to assess participants' comprehension. A qualitative approach was used, involving four open-ended questions. Summary statistics and descriptive analysis were utilized to describe survey answers.

The survey was answered by 70 clinicians, 56% (n=39) medical oncologists, 24% (n=17) radiation oncologists, 7% (n=5) surgeons, and the remaining 13% (n=9) from anatomical pathology, radiology, and palliative care. The three clinical cases were correctly identified as oligo-recurrence, de-novo, and oligo-progression disease in 63% (n=44), 94% (n=66), and 76% (n=53) of responses, respectively. Additionally, for each case, the majority of respondents indicated that they would offer local treatment (n=59, 84%; n=57, 81%; n=55, 79%, respectively). Seventy-nine percent (n=49) perceived differences between each modality of local therapies. Physicians perceived challenges including the lack of prospective trial data and unclear approach to OMD. An important determinant in deciding whether patients may benefit from treatment was tumor histology.

The term OMD involves certain difficulties in definition and management. Positive and negative trials have further added uncertainty regarding who would best benefit from local treatment. The discordance in outcome expectations from physicians and patients will need to be addressed to ensure that patient's goals of care are met.