GAIL J ROBOZ, MD: My impression here in New York is that many oncologists in practice make an effort to send patients with AML to an academic setting, but it would be interesting to see how this relates to geography and distance from tertiary centers.
DR LOVE: Our CME group is presenting a poster at ASH on how 203 patients with newly diagnosed myeloma were managed in community practice since 2008. It would be interesting to do the same thing in AML and, for that matter, MDS, and see what was going on.
DR ROBOZ: That would be an incredible piece of work. I would love to work with you on that. When we go out and give lectures and talk about clinical trials and so forth, I think we all have in our minds that there are threshold levels of commuting, but if we could actually figure out the key factors, it would be fascinating.
DR LOVE: I was surprised that so many physicians in this survey generally manage patients with AML, as opposed to referring them to an academic center.
DR ROBOZ: I have definitely heard it said on a reasonably regular basis that, first of all, the data with AML have not convincingly shown that anything is better than “7 + 3,” and secondly, that academic data have not shown — especially for older patients — a significant improvement in overall survival. So a lot of people in the community say, “What’s the point in referring?” — and it’s tough to argue with that.
In private practice, if you’re really convinced that a patient has a disease that by going to a tertiary center, will result in a better outcome, you’re going to refer the patient. But some physicians question putting patients through a miserable commute and uprooting them from their families when the outcome is going to be the same anyway.
DR LOVE: Interesting. OK so we’ll see what you and Dr Giagounidis think about the other findings in this survey and these cases in New Orleans a week from Friday.
Dr Roboz is Associate Professor of Medicine and Director of the Leukemia Program at Weill Medical College of Cornell University at NewYork-Presbyterian Hospital in New York, New York.
