Results of questionnaire on decision-making to treat advanced non-small cell lung cancer based on American and European practical guidelines

During 2009, practical routine guidelines for advanced non-small cell lung cancer used in Europe or USA were updated because the clinical benefits of molecular target agents were confirmed through several pivotal clinical trials. These molecular target agents appeared in guidelines which became available in Japan by the end of 2009. We made a questionnaire for decision-making to treat advanced non-small cell lung cancer based on these practical guidelines. Oncologists of lung cancer working in the Shinjuku area of Tokyo in Japan were eligible. Between March 15th and April 9th in 2010, 28 oncologists from 12 departments in 7 hospitals completed this questionnaire. Most of them made the global standard decision-making according to the new guidelines, including new proposals such as usage of epidermal growth factor receptor-tyrosine kinase inhibitors. There were 3 differences from the guidelines. 1) Platinum doublets were selected even in 2nd- or 3rd-line treatment because of the expected tumor shrinkage. 2) Single cytotoxic agents were selected even for 3rd-line treatment. The tendency of a backward shift in decision-making was observed. 3) There were few selections of regimens including bevacizumab because of medical systems such as DPC (Diagnosis Procedure Combination) that is Japanese DRG (Diagnosis-Related Group)/PPS (Prospective Payment System).