Doctor-doctor communication of prognosis in metastatic cancer: a review of letters from medical oncologists to referring doctors — ASN Events
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Doctor-doctor communication of prognosis in metastatic cancer: a review of letters from medical oncologists to referring doctors (#396)

Erin B Moth 1 , Philip Beale 1 2 3 , Prunella Blinman 1 3 , Stephen Della-Fiorentina 4 , Jane Parry 4 , Martin R Stockler 1 5 , Belinda E Kiely 1 4 5
  1. Concord Cancer Centre, Concord, NSW, Australia
  2. Cancer Services and Palliative Care, Sydney Local Health District, Sydney, NSW, Australia
  3. University of Sydney, Sydney, NSW, Australia
  4. Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
  5. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia

Aims
To describe the prognostic information included in written correspondence from medical oncologists to referring doctors for patients with metastatic cancer.

Methods
We reviewed initial and subsequent consultation letters for all new patients with metastatic cancer presenting to 13 medical oncologists and 16 registrars at Concord and Macarthur Cancer Centres between June 2012 and June 2013. We recorded the presence and nature of prognostic information in the letters, and patients’ baseline characteristics. We explored characteristics associated with the inclusion of prognostic information.

Results
We analysed 1344 letters pertaining to 272 patients. Patients’ characteristics were: male 64%; median age 68; primary cancer of lung 28%, upper gastrointestinal 21%, genitourinary 14%, colorectal 14%, and other 23%. Systemic therapy was planned in 77%. After a median follow up of 15 months, 145 patients had died with a median overall survival of 13 months. The average number of letters per patient was 5, with 50% written by consultants. The terms “metastatic” or “stage IV” cancer were included in the letters for most patients (93%), treatment was described as “palliative” for 64% and the word “incurable” was included for 34%. Only 31 patients (11%) had a quantitative estimate of their prognosis in any correspondence: median/average survival in 14; general time frame in 12; and, best-case, typical and worst-case scenarios in 5. For 16 of these 31 patients the quantitative estimate was in their initial letter. The inclusion of quantitative prognostic information was not associated with patient age, cancer type, treatment plan, consultant authoring letter, or survival.

Conclusion
While most written correspondence from medical oncologists regarding their patients with metastatic cancer included qualitative prognostic information, few letters included quantitative prognostic information. We propose that communication between medical oncologists, referring doctors, and patients would be improved if medical oncologists included quantitative prognostic information in their consultation letters.

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