TY - JOUR
T1 - Surgical Referral for Colorectal Liver Metastases
T2 - A Population-Based Survey
AU - Krell, Robert W.
AU - Reames, Bradley N.
AU - Hendren, Samantha
AU - Frankel, Timothy L.
AU - Pawlik, Timothy M.
AU - Chung, Mathew
AU - Kwon, David
AU - Wong, Sandra L.
PY - 2015/7/8
Y1 - 2015/7/8
N2 - Background: Surgical resection is underutilized for patients with colorectal liver metastases (CLM). Although the causes of underutilization are poorly understood, provider attitudes towards surgical referral may be contributory. We sought to understand medical oncologists’ perspectives on referral for CLM. Methods: Medical oncologists who treat colorectal cancer in the US state of Michigan were surveyed. We characterized respondents’ attitudes regarding clinical and tumor-related contraindications to liver resection for CLM, as well as referral and treatment preferences using case-based scenarios. We then evaluated practice characteristics and treatment preferences between physicians. Results: A total of 112 eligible responses were received (46 % response rate). Nearly 40 % of respondents reported having no liver surgeons in their practice area. Commonly perceived contraindications to liver resection included extrahepatic disease (80.3 %), poor performance status (77.7 %), the presence of >4 metastases (62.5 %), bilobar metastases (43.8 %), and metastasis size >5 cm (40.2 %). Compared with high-referring physicians, low-referring physicians were just as likely to refer a patient with very low recurrence risk (89.3 vs. 98.3 %; p = 0.099), but much less likely to refer a patient with moderate risk (0 vs. 82.8 %; p
AB - Background: Surgical resection is underutilized for patients with colorectal liver metastases (CLM). Although the causes of underutilization are poorly understood, provider attitudes towards surgical referral may be contributory. We sought to understand medical oncologists’ perspectives on referral for CLM. Methods: Medical oncologists who treat colorectal cancer in the US state of Michigan were surveyed. We characterized respondents’ attitudes regarding clinical and tumor-related contraindications to liver resection for CLM, as well as referral and treatment preferences using case-based scenarios. We then evaluated practice characteristics and treatment preferences between physicians. Results: A total of 112 eligible responses were received (46 % response rate). Nearly 40 % of respondents reported having no liver surgeons in their practice area. Commonly perceived contraindications to liver resection included extrahepatic disease (80.3 %), poor performance status (77.7 %), the presence of >4 metastases (62.5 %), bilobar metastases (43.8 %), and metastasis size >5 cm (40.2 %). Compared with high-referring physicians, low-referring physicians were just as likely to refer a patient with very low recurrence risk (89.3 vs. 98.3 %; p = 0.099), but much less likely to refer a patient with moderate risk (0 vs. 82.8 %; p
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U2 - 10.1245/s10434-014-4318-x
DO - 10.1245/s10434-014-4318-x
M3 - Article
C2 - 25582739
AN - SCOPUS:84930478329
SN - 1068-9265
VL - 22
SP - 2179
EP - 2194
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 7
ER -