Reviewing the lines of therapy-concept in cancer treatment: a survey study among physicians

While the line of therapy (LOT) concept is crucial for clinical decision-making in oncology, the concept lacks a consensual understanding bearing the risk of miscommunication. This study examines physicians' understanding of LOT, its perceived relevance, and the events and actions that determine a change of LOT within German oncological networks.

Employing a snowball sampling approach, an anonymous online-administered survey was conducted among German physicians with oncological experience. Descriptive statistics and consensus metrics (Gini Mean Difference [GMD] and normalized entropy) were used to summarize the survey results and the relative agreement among the respondents, respectively.

Sixty physicians completed the survey. The majority were permanent members of an oncological tumor board (N = 46; 76.7%) and worked as a chief or senior physician (N = 37; 61.7%). Most respondents (N = 57, 95.0%) agreed that the LOT concept describes a planned therapeutic approach with a specified goal. Progression (N = 58; 96.7%), recurrence (N = 52; 86.7%), metastasis occurrence (N = 55; 91.7%), or severe side-effects (N = 46; 76.7%) were considered indicators prompting a change of LOT. Consideration of local therapeutic interventions (e.g., surgery (N = 20; 37.0%; GMD = 0.55, 95%-CI = [0.43; 0.64]) as independent LOT was widely disputed.

This study reveals both commonalities and inconsistencies in physicians' understanding of LOT in cancer treatment in Germany. Findings support the need for a greater standardization or refinement of the LOT concept which could help to minimize clinical misunderstandings and may enhance patient treatment strategies.