Oncologists Highlight Treatment, Patient Attributes That Impact Decision-making for CLL

With a variety of treatments available for chronic lymphocytic leukemia (CLL), a disease that is extremely heterogeneous, clinicians are faced with a challenging task to choose the right treatment for a patient.

A poster presented at Virtual ISPOR 2021 found that when they need to make evidence-based decisions, oncologists consider efficacy the most important attribute when making a treatment selection.

“Treatment for CLL has advanced tremendously over the last 5 years with the introduction of newer classes of drugs that target various biological pathways associated with this disease,” the authors wrote.

They conducted a cross-sectional survey from October 2019 to January 2020 among a convenience sample of medical oncologists who are currently practicing medicine in the United States, board certified in hematology and/or oncology, and currently treating patients with CLL and known IGHV status.

Fifty oncologists responded, mostly male (84%) with a mean age of 46.1 years and a mean 14.5 years of practice. More than half (62%) practiced both hematology and oncology, 28% practiced oncology, and 10% practiced hematology. The majority of respondents were White or Asian (90%) and community based (64%). The mean number of CLL patients each clinician was treating was 53.

The 5 most important treatment attributes were overall survival, progression-free survival, grade 3/4 tumor lysis syndrome, grade 3/4 atrial fibrillation, and administration route (oral vs intravenous). Least important treatment attributes were grade 3/4 rash and cycle duration (fixed vs to progression).

The respondents were asked to review clinical vignettes and provide treatment recommendations. The responses revealed that a mean of 61% of oncologists preferred oral targeted monotherapy for patients with CLL regardless of their IGHV status.

The majority of oncologists indicated patients were involved decision makers, with 84% saying they understood their patients’ treatment preferences/goals and 92% saying that patients had “complete/some” participation in treatment decision-making. In addition, almost all said they often/always recommend genetic variation testing for IGHV (84%), del17p (90%), del11q (84%), and TP53 (78%).

The researchers highlighted 2 limitations: first, that the survey focused only on IGHV mutation; and second, a study based on physicians’ experiences may be subject to recall errors.

“This study is an important step in understanding how treatment and patient attributes impact clinician recommendations,” the authors wrote.

Reference

Sharma D, Deering KL, Sundaram M, Daly K, Huang Q. Impact of treatment and patient attributes on oncologists decision-making in first-line chronic lymphocytic leukemia (CLL) in the United States (US). Presented at: Virtual ISPOR 2021; May 17-20, 2021. Poster PCN164.