Health Care Consultants Publish Research on Risk of Tumor Recurrence

August 17, 2015

For patients diagnosed with the rare neoplasm, gastrointestinal stromal tumor (GIST), removal of the tumor with complete surgical resection can often be curative, but tumors can recur. For patients with resected tumors recognized to be at high risk of recurrence, adjuvant therapy can extend patients' recurrence-free survival after resection. Despite the availability of several tools to assess the risk of GIST recurrence, no standard has emerged, and some physicians opt to rely on their own assessments. A team from Analysis Group contributed to a study to assess "the extent of physician underestimation of the risk of recurrence after complete primary GIST resection" and to determine how this underestimation affected adjuvant treatment duration that followed primary treatment, as well as "the association among high-risk patients between adjuvant treatment duration and recurrence-free survival." 

The study, "Physician Underestimation of the Risk of Gastrointestinal Stromal Recurrence After Resection" (JAMA Oncology, July 23, 2015), applied a retrospective observational medical record review of 109 U.S. oncologists who reported information on 506 patients with GIST after primary resection. The researchers, including Managing Principal Eric Wu, Vice President Annie Guérin, Senior Economist Genevieve Gauthier, and Associate Alexander R. Macalalad, found that "physicians tended to underestimate the risk of recurrence for many patients with GIST." Compared to the risk level assessed based on the Revised National Institutes of Health (NIH) Consensus Criteria, physicians consistently estimated the risk for 53.4% of patients, but they underestimated the risk for 37.5% of patients and overestimated the risk for 9.1%. The extent of underestimation was particularly high among patients with "tumors of intermediate size, intermediate-level mitotic count, and nongastric location." This risk underestimation had an impact on planned adjuvant therapy duration; among high-risk patients, more patients in the not-underestimated group (65.9%) had a treatment plan of three or more years of adjuvant therapy compared to patients in the underestimated group (36.1%). The study also showed that patients with "at least 3 years of planned adjuvant treatment" tended to have longer recurrence-free survival. Ultimately, the authors concluded that the tendency of physicians to underestimate the risk of recurrence combined with the importance of planned adjuvant treatment duration for recurrence-free survival for high-risk patients suggest that there is a need for improved education on the role of accurate post-resection risk assessment and appropriate adjuvant treatment in improving long-term outcomes for these patients. 

These findings were featured in a recent article, "GIST Recurrence Risk Underestimated 'in a Third of Patients'" (Medscape Medical News, August 10, 2015), in which study coauthor Dr. Macalalad reflected on the importance of major risk assessment tools relative to physicians' tendency to underestimate risk: "I think physicians underappreciate how much risk can change if that type of tumor [small or with a low mitotic count] is found, say, outside of the stomach, in the small intestine, or in another area . . . . Becoming more aligned on these tools can hopefully guide them to recognize that some of these benign-looking tumors really do have a recurrence potential, and they need to give adjuvant treatment for that." 

Read the study abstract

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