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Taking care of the patient with cancer: How treatment practices vary by the experience of the treating oncologist.

e19665 Background: Oncologists have multiple choices in managing their patients. With biologic agents unique toxicites are being seen. These agents require new basic science knowledge and diagnostic skills. As oncologists age and get further away from their academic training, just how comfortable are they in caring for patients and how clinically competent are they? Are oncologists taking care of the entire patient or are they just giving drugs to treat their patient's disease?


METHODS
37 of the 50 invited community oncologists participated in this study. There were 40 questions with 10 patient vignettes dealing with various medical and psychosocial issues involved in the treatment of advanced stage cancer. An analysis was done between oncologists in practice less than 10 years (15), from 10 to 20 (8) and over 20 (14).


RESULTS
The younger physicians better understood the mode of action of the newer agents. All respondents felt comfortable using them even as the newer toxicities required care from other specialties. Attendence at ASCO was not a high priority for any group.The older oncologists thought that ASCO attendence had become "irrelevant" due to a host of reasons. All respondents felt that CME courses "on-line" and local and regional meetings gave them the information that they needed to care for their patients. Their understanding of statistical end points in clinical trials was equally poor. All groups used consultants for cardiopulmonary issues while the older physicians were more comfortable handling the septic neutropenic patient. The younger physicians were uncomfortable and less knowledgeable in dealing with psychosocial issues. They relied quite heavily on others while the experienced physicians handled these issues with little difficulty or stress.


CONCLUSIONS
The more experienced oncologist were more comfortable dealing with palliative and end of life issues. They also used subspecialty colleagues less often by doing more "general internist" work. Attendence at the ASCO annual meeting is of much less importance as many of the respondents felt that "cost-benefit" strongly favored not attending but going to a post-ASCO review course and other locoregional events.