Practice patterns, attitudes, and knowledge among physicians regarding cytoreductive surgery and HIPEC for patients with peritoneal metastases

Abstract

BackgroundCytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is a treatment option for patients with peritoneal metastases shown to provide improved overall survival for appropriately selected patients. However, the availability and utilization of this treatment remains limited. The aim of this survey-based study was to evaluate factors influencing physician treatment choices for peritoneal metastases.MethodsSurveys were mailed to medical oncologists and surgeons in Virginia, Maryland, and Washington, D.C. Survey questions evaluated access to HIPEC centers, prior experience with referral to HIPEC centers, opinions regarding efficacy, and knowledge regarding outcomes of CRS and HIPEC.ResultsSurveys were mailed to 2279 physicians; 116 eligible surveys were returned. Seventy-five percent of respondents would consider referral to a HIPEC center for appendiceal peritoneal metastasis, while only 50% would consider it for colon cancer and peritoneal mesothelioma. The most common reason for never referring a patient to a HIPEC center was lack of access to a HIPEC specialist (47%) followed by perceived lack of evidence for the treatment modality (31%). Five-year survival after CRS and HIPEC was underestimated while 30-day mortality was overestimated by more than half of respondents.ConclusionsReferral to HIPEC centers is underutilized among community physicians in practice. Limited access to HIPEC experts is the most common cause for lack of referral, followed by a perception of insufficient evidence for this treatment approach. Lack of familiarity with data regarding outcomes impacts referral patterns and treatment choices. Possible actions to increase awareness and appropriate utilization of CRS and HIPEC are suggested.

Surgical and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a nonacademic center: 25‐year experience

“…While the incidence continues to increase, access to PSM experts remains limited, with many CRS/HIPEC centers located in academic institutions due to its inherent complexity and investigational nature for some primaries 7‐9 . This leads to insufficient referrals of patients who desperately need treatment 10 …”

Perceptions in the management of colorectal peritoneal metastases: A bi-national survey of colorectal surgeons

“…However, our response rate of 36.2% is much higher that other similar international surveys in this field [12,13,46]. Furthermore, while most other surveys [12,13,47,48] have assessed clinician views and awareness on effectiveness and safety of CRS and HIPEC, our survey and a recent Swiss survey [46] served to evaluate how clinicians view and manage commonly encountered cases with peritoneal disease, as timely, appropriate and evidence based care in such cases translates to better clinical outcomes. While this survey covered the use of HIPEC, it failed to evaluate the role of other intraperitoneal chemotherapy modalities such as early postoperative intraperitoneal chemotherapy (EPIC) or pressurised aerosolised chemotherapy (PIPAC).…”

“…However, it is unclear whether skepticism is due to lack of awareness and knowledge among clinicians in the management of peritoneal disease. Recent studies have shown that poor awareness of the value of the CRS and HIPEC in the management of colorectal peritoneal metastases (CRPM) contributes to reduced utilisation of CRS and HIPEC [12,13].…”

Practice patterns, attitudes, and knowledge among clinicians regarding hyperthermic intraperitoneal chemotherapy and pressurized intraperitoneal aerosol chemotherapy: a national survey by Indian society of peritoneal surface malignancies (ISPSM)

“…Limited adoption and access of CRS/HIPEC for patients underlines the scepticism among the clinicians about its role and efficacy despite mounting evidence. Poor knowledge of procedure and benefit is one of the most important reasons for underutilization [ 13 ], [ 16 ], [ 17 ]. This procedure is technically challenging with high morbidity and mortality, needing an institutional setup with well-equipped OT, anaesthetic and intensive care departments.…”