Is Oligometastatic Cancer Curable? A Survey of Oncologist Perspectives, Decision Making, and Communication

Hae Lin Cho; Tracy Balboni; Sebastian Matthias Christ; Brandon Turner; Alexander Spektor; Subha Perni

doi:10.1016/j.adro.2023.101221

Is Oligometastatic Cancer Curable? A Survey of Oncologist Perspectives, Decision Making, and Communication

Adv Radiat Oncol. 2023 Mar 18;8(5):101221. doi: 10.1016/j.adro.2023.101221. eCollection 2023 Sep-Oct.

Authors

Hae Lin Cho¹, Tracy Balboni², Sebastian Matthias Christ^{2

3}, Brandon Turner², Alexander Spektor², Subha Perni⁴

Affiliations

¹ Harvard Medical School, Boston, Massachusetts.
² Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts.
³ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Department of Radiation Oncology and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.

Abstract

Purpose: Oligometastatic disease (OMD) refers to a limited state of metastatic cancer, which potentially derives benefit from local treatments. Given the relative novelty of this paradigm, oncologist perspectives on OMD are not well established. We thus explored oncologist views on curability of and treatment recommendations for patients with OMD.

Methods and materials: We developed a survey focused on oncologist views of 3 subtypes of OMD: synchronous, oligorecurrent, and oligoprogressive. Eligible participants included medical and radiation oncologists at 2 large cancer centers invited to participate between May and June 2022. Participants were presented with 3 hypothetical patient scenarios and asked about treatment recommendations, rationale, and demographic information.

Results: Of 44 respondents, over half (61.4%) agreed that synchronous OMD is curable. A smaller proportion (46.2% and 13.5%) agreed for oligorecurrence and oligoprogression, respectively. When asked whether they use the word "cure" or "curative" in discussing prognosis, 31.8% and 33.3% agreed for synchronous and oligorecurrent OMD, respectively, while 78.4% disagreed for oligoprogression. Views on curability did not significantly affect treatment recommendations. More medical oncologists recommended systemic treatment only compared with radiation oncologists for the synchronous OMD (50.0% vs 5.3%; P < .01) and oligoprogression cases (43.8% vs 10.5%; P = .02), not the oligorecurrent case. There were no significant differences in confidence in treatment recommendations by specialty.

Conclusions: In this exploratory study, we found notable divergence in oncologists' views about curability of OMD as well as variability in treatment recommendations, suggesting need for more robust research on outcomes of patients with OMD.