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Optimal timing for initiating first-line palliative systemic therapy in asymptomatic metastatic esophagogastric cancer: Insights from a European Delphi study
D. Kamp, AM. May, A. Adenis, A. Capela, S. Derks, F. De Felice, NF. Dovnik, C. Hierro, A. Ilhan-Mutlu, F. Lordick, RL. Obermannova, A. Petrillo, A. Puccini, A. Raimundo, G. Roviello, A. Siebenhüner, M. Slingerland, EC. Smyth, HWM. van Laarhoven,...
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články
- MeSH
- asymptomatické nemoci terapie MeSH
- čas zasáhnout při rozvinutí nemoci MeSH
- časové faktory MeSH
- delfská metoda * MeSH
- konsensus MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory jícnu * patologie farmakoterapie MeSH
- nádory žaludku * farmakoterapie patologie MeSH
- paliativní péče * metody MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: The enhanced application of imaging techniques is resulting in the diagnosis of more patients with asymptomatic metastatic esophagogastric cancer (mEGC). We conducted a Delphi study to gather insights from European experts on the optimal timing for initiating palliative systemic therapy for these patients. METHODS: An online survey featured 14 scenarios where physicians chose their preferred timing for initiating systemic therapy: immediate(<3 weeks) or deferred. The standard scenario was a 65-year-old male, WHO/ECOG 0 with asymptomatic mEGC, 2 metastases in each lung, HER2 -, PDL1-CPS 2. In every subsequent case, one characteristic was modified. To investigate the fortitude of the physicians' preference for an immediate start, scenarios also included a patient who was motivated to start but preferred to defer if the physician deemed it judicious. Consensus was defined as ≥ 75 % agreement; scenarios without consensus were re-evaluated in Delphi round 2. RESULTS: Thirty-nine physicians participated in the first round, and 33 in the second round. Consensus to start treatment immediately was reached in 12 (86 %) scenarios. When patients preferred to defer, the consensus was to still advise to start palliative systemic treatment immediately in half (n = 7) of the scenarios. Only 2 scenarios (pre-existent WHO/ECOG 2 or 78 years old) reached the consensus that treatment could be deferred. CONCLUSIONS: In asymptomatic mEGC, immediate start of treatment is preferred by European experts. Consensus was established that treatment can be deferred for patients who prefer deferral and either have a pre-existent WHO/ECOG performance status of 2 or are of advanced age.
Cancer Center Amsterdam Cancer Treatment and Quality of Life Amsterdam the Netherlands
Clinic for Hematology and Oncology Hirslanden Zurich AG Zurich Switzerland
Department of Medical Oncology Amsterdam UMC Free University Amsterdam the Netherlands
Department of Medical Oncology Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
Department of Medical Oncology CUF Tejo Lisbon Portugal
Department of Medical Oncology Leiden University Medical Center Leiden the Netherlands
Department of Medical Oncology Unidade Local de Saúde de Gaia e Espinho Villa Nova de Gaia Portugal
Department of Oncology Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
Department of Oncology University Medical Centre Maribor Maribor Slovenia
Division of Oncology Department of Medicine 1 Medical University of Vienna Vienna Austria
Medical Oncology Department Catalan Institute of Oncology Barcelona Spain
Medical Oncology department Institut du Cancer de Montpellier Montpellier France
Medical Oncology unit Ospedale del Mare Via E Russo Naples Italy
University Cancer Center Leipzig University of Leipzig Leipzig Germany
Citace poskytuje Crossref.org
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- $a BACKGROUND: The enhanced application of imaging techniques is resulting in the diagnosis of more patients with asymptomatic metastatic esophagogastric cancer (mEGC). We conducted a Delphi study to gather insights from European experts on the optimal timing for initiating palliative systemic therapy for these patients. METHODS: An online survey featured 14 scenarios where physicians chose their preferred timing for initiating systemic therapy: immediate(<3 weeks) or deferred. The standard scenario was a 65-year-old male, WHO/ECOG 0 with asymptomatic mEGC, 2 metastases in each lung, HER2 -, PDL1-CPS 2. In every subsequent case, one characteristic was modified. To investigate the fortitude of the physicians' preference for an immediate start, scenarios also included a patient who was motivated to start but preferred to defer if the physician deemed it judicious. Consensus was defined as ≥ 75 % agreement; scenarios without consensus were re-evaluated in Delphi round 2. RESULTS: Thirty-nine physicians participated in the first round, and 33 in the second round. Consensus to start treatment immediately was reached in 12 (86 %) scenarios. When patients preferred to defer, the consensus was to still advise to start palliative systemic treatment immediately in half (n = 7) of the scenarios. Only 2 scenarios (pre-existent WHO/ECOG 2 or 78 years old) reached the consensus that treatment could be deferred. CONCLUSIONS: In asymptomatic mEGC, immediate start of treatment is preferred by European experts. Consensus was established that treatment can be deferred for patients who prefer deferral and either have a pre-existent WHO/ECOG performance status of 2 or are of advanced age.
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