Pearson, April, MS

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTPilot Survey for a Nation-wide Patterns of CareStudy on How Radiation Oncologists Treat GastricCancerApril Pearson MSUSF MCOM- LVHN Campus, april.pearson@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtPearson, A. (2016, March 9). Pilot Survey for a Nation-wide Patterns of Care Study on How Radiation Oncologists Treat Gastric Cancer.Poster presented at: The SELECT Capstone Project in the Kasych Conference Room, Lehigh Valley Health Network, Allentown, PA.  BackgroundA 17 question survey was drafted with questions asking radiation oncologists how they treat their patients with gastric cancer.  11 questions were specific to treatment while the other 6 questions asked the surveyor about their demographics and the percentage of patients they treat with gastric cancer on a yearly basis.  The survey was piloted amongst 6 radiation oncologists at LVHN to ensure the questions are clearly understood with no room for misinterpretation.  This survey is in the process of being approved by the Department of Medicine Research Review Committee.  After full IRB approval the survey will be distributed to 300 radiation oncologists through the ASTRO USA database.Gastric cancer is the 4th most common cancer, and 2nd leading cause of cancer-related deaths worldwide.  In most cases, surgical resection is the mainstay of treatment, however many times the tumor is found late-stage and there are questions as to how to treat these patients.  First, the type of surgery performed, and how extensive of a lymph node dissection should be done is highly contested.  Secondly, what is the role of chemotherapy and radiotherapy treatment?   In the studies that have been conducted so far, it is clear that adjuvant therapy is significantly beneficial.  However, there is no internationally accepted standard of care established for this adjuvant therapy.  The treatment of gastric cancer is not thoroughly studied, therefore radiation oncologists and medical oncologists alike utilize a great variety of treatment options.  More studies are needed to evaluate the role of radiotherapy, as well as what is currently being practiced by radiation oncologists.  The purpose of this study was to pilot a survey at LVHN with the final intention of distributing this survey nationally to determine what strategies are being utilized to treat gastric cancer by radiation oncologists throughout the United States.© 2016 Lehigh Valley Health NetworkMethodologyThe results of our initial pilot survey showed agreement on some items between the 6 radiation oncologists at LVHN, and disagreement on others.  All 6 radiation oncologists discuss about 30-49% of their gastric cancer patients at tumor board.  Everyone agreed that a D2 nodal dissection is performed during a gastrectomy at LVHN, and everyone utilizes perioperative therapy when treating a T2 or higher, node negative gastric cancer after D2 dissection.   Furthermore there was concurrence between all 6 radiation oncologists with giving a dose between 50-55Gy, using respiratory gating or 4DCT for treatment planning, and always using image guided radiotherapy during treatment of their gastric cancer patients.  There were also some points of contention.  One radiation oncologist stated they recommended postoperative chemotherapy alone for their patients with T2 or higher, node negative gastric cancer after D2 dissection, while the other 5 physicians recommend postoperative chemotherapy plus radiation.  Four surveyors states they took into consideration the histologic subtype into consideration of their therapy recommendations, while the other 2 radiation oncologists did not.  For radiotherapy delivery, 2 radiation oncologists use intensity modulated radiation therapy (IMRT) alone, where as the other 4 surveyors used IMRT with cone beam CT image guidance and simultaneous integrated boost.  Lastly, there are two different chemotherapy regimens being used at LVHN – the first being ECF based off the MAGIC trial and the second is 5FU-based + Oxaliplatin based off the CLASSIC trial.  Results With just the initial pilot survey we see that in the same institution, there are some areas which radiation oncologists practice similarly, and there are other areas where there are differences in how radiation oncologists treat their patients with gastric cancer.  It is expected that this trend will be seen in the nation-wide survey.Conclusions How is gastric cancer being treated by radiation oncologists in the United States?Problem StatementLehigh Valley Health Network, Allentown, PAPilot Survey for a Nation-wide Patterns of Care Study on How Radiation Oncologists Treat Gastric CancerApril Pearson

Pilot Survey for a Nation-wide Patterns of Care Study on How Radiation Oncologists Treat Gastric Cancer

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1105&context=select-program

Pilot Survey for a Nation-wide Patterns of Care Study on How Radiation Oncologists Treat Gastric Cancer

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