Poster & Mini Oral Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

Assessing the medical workforces perceived barriers to the prescription of risk-reducing medication for women at moderate and high risk of breast cancer (#198)

Sarah Sutherland 1 , Bettina Meiser 2 , Gillian Mitchell 3 , Judy Kirk 4 , Michelle Peate 2 5 , TIm Wong 6 , Rajneesh Kaur 2 , Annabel Goodwin 1
  1. Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, NSW, Australia
  2. Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
  3. Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  4. Familial Cancer Service, Crown Princes Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
  5. Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
  6. School of Social Sciences, UNSW, Sydney, NSW, Australia

Aim:

To assess the attitudes of Australian health professionals to tamoxifen as a risk-reducing medication (RRM). To identify barriers to prescription due to workforce issues, risk assessment skills, willingness to initiate or monitor whilst on RRM.

Method:                                                                     

Members of relevant medical organizations in Australia and New Zealand were invited to participate in a web-based survey aiming to accrue 240 participants.

Results:

100 participants were recruited including 33 genetic health professionals, 32 medical oncologists and 20 surgeons following which it was closed due to slow accrual. 99% of respondents perceived tamoxifen to be effective.

Overall respondents felt that assessing a patient’s personal risk of breast cancer should be performed by cancer specific services such as cancer geneticists (74%) or medical oncologist (66%) rather than GPs (26%). Genetic health professionals and surgeons were more aware of risk assessment tools such as BOADICEA than medical oncologists (p< 0.001). Respondents felt that cancer geneticist (84%) and medical oncologists (85%) should be responsible for discussing the potential use of tamoxifen. Medical oncologists were favoured over cancer geneticists to initiate prescription (83% v’s 56%) and monitor (72% v’s 33%) tamoxifen use. Most felt GPs could also monitor (64%).

The most frequently identified barrier to physician prescription was a feeling that it wasn’t their role (50%) Genetic health professionals felt this more than medical oncologists (85% v’s 28%). At risk women are being seen at low rates with only 14 % of respondents seeing > 100 patients per year. Whilst 75% of respondents were happy to oversee more patients on RRM, only 10% of health professionals were willing to see > 49 additional patients per year indicating a workforce issue.

Conclusions:

Despite tamoxifen as a RRM being widely accepted to be effective by health professionals there are still significant barriers to its prescription including workforce issues.