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Challenges in the Understanding of Oligometastatic Disease in Clinical Practice
Inmaculada Navarro-Domenech1,2, Aisling Barry3, Jane Tsai4
1Radiation Oncology, Hospital Universitario La Paz, Madrid, ESP.
Abstract:
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.
Materials And Methods:
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.
Results:
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.
Conclusion:
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.
Insights
This study surveyed clinicians on oligometastatic disease (OMD) management, revealing knowledge gaps and challenges. Findings highlight the need for clearer guidelines and better patient-physician communication regarding OMD treatment.
Area of Science:
- Oncology
- Clinical Decision-Making
- Quality Improvement
Background:
- Oligometastatic disease (OMD) management lacks comprehensive data and clear decision-making protocols.
- Understanding clinician knowledge gaps and challenges is crucial for improving OMD treatment delivery.
Purpose of the Study:
- To assess clinician comprehension of different oligometastatic disease scenarios.
- To identify challenges and knowledge gaps in the diagnosis and treatment of OMD.
- To evaluate current approaches to managing oligometastatic disease.
Main Methods:
- A quality improvement (QI) study utilizing an anonymous survey.
- Presented three distinct clinical scenarios of OMD for participant assessment.
- Employed a qualitative approach with open-ended questions and analyzed responses using descriptive statistics.
Main Results:
- 70 clinicians participated, primarily medical and radiation oncologists.
- Accurate identification of OMD subtypes varied (63%-94%), with a majority favoring local treatment.
- Key challenges identified include lack of prospective trial data, unclear management strategies, and tumor histology as a key treatment determinant.
Conclusions:
- Oligometastatic disease presents definition and management challenges.
- Uncertainty exists regarding optimal local treatment benefits due to mixed trial results.
- Addressing discordance in patient and physician expectations is vital for aligned goals of care.
