Challenges That Hinder the Translation of Clinical Advances Into Practice: Results From an International Assessment in Colorectal Cancer

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Abstract

Developments in mutation analysis have added to the complexity of treatment selection. In this mixed methods study, with a sample of 358 oncologists from 7 countries, we aimed to identify international clinical practice challenges regarding colorectal cancer treatment. Findings indicate that treatment selection is hindered by 6 substantive challenges, which have the potential to inform the development of interventions to improve practice.

Background

Over the past decade, individualization of treatment for colorectal cancer (CRC) has been improved by: (1) approval of several new agents by national agencies such as the US Food and Drug Administration (FDA); and (2) rapid advances in mutation analysis. However, data are sparse on the clinical challenges experienced by oncologists as they address the increased complexity created by the growing potential for individualization of CRC treatment.

Materials and Methods

To identify clinical challenges experienced by oncologists regarding CRC treatment, an international assessment was conducted. A mixed methods approach was used, with the collection and analysis of qualitative (semistructured telephone interviews) and quantitative (online survey) data. Participants were oncologists actively practicing in 1 of 7 targeted countries with a minimum caseload of 10 CRC patients per year.

Results

The sample included 358 oncologists from China (n = 68), France (n = 44), Germany (n = 44), Italy (n = 45), Spain (n = 44), the United Kingdom (n = 45), and the United States (n = 68). Mixed methods findings indicated that oncologists' treatment selection is hindered by practice challenges in: (1) mutation analysis and subsequent adaptation of treatment; (2) optimal sequential use of treatment choices; (3) treatment individualization based on patient and tumor profile; (4) management of side effects and toxicities; (5) chemoresistance, cross-resistance, and combinations to overcome resistance; and (6) access to new emerging treatments.

Conclusion

In the context of increased complexity created by the approval of new agents and advances in mutation analysis, challenges are experienced by practicing oncologists in the individualization of treatment for CRC patients. Details of these challenges should stimulate dialogue among oncologists, and development of interventions to improve clinical practice.

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