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Background <p>For the treatment of colorectal cancer, the S3-Guideline of the German Guideline Program in Oncology supports clinical decision-making. Centers certified by the German Cancer Society are required to implement the guideline recommendations as comprehensively as possible. When guidelines provide insufficient or ambiguous evidence, heterogeneity of treatment preferences is likely to emerge across individual centers. The aim of this study is to describe the preferences of the centers’ tumor boards for treatment decisions when clear, evidence-based guideline recommendations are lacking.</p> Methods <p>To investigate the tumor boards’ preferences for different treatment options, an anonymous online survey was conducted among 314 certified colorectal cancer centers. The survey included seven visceral oncological and nine visceral surgical case vignettes. Centers were asked to discuss the vignettes in the tumor board or, alternatively, delegate them to an appropriate physician representatively speaking for the tumor board. The responses were analyzed descriptively and normalized entropy estimates (NE) were calculated for each vignette.</p> Results <p>A total of 123 centers (39%) responded to the survey. For oncological cases without clear guideline recommendations, substantial heterogeneity (NE: 0.39–0.71) in treatment preferences was observed. For instance, opinions varied widely for UICC II pT4a colon cancer. In this situation, 28% of centers would prefer fluoropyrimidine monotherapy, 39% oxaliplatin-based combination therapy and 33% no adjuvant chemotherapy at all. Surgical vignettes showed a preference for laparoscopic and robotic approaches, with variations based on tumor location (NE: 0.46–0.67). Importantly, in case of a clear evidence-based guideline recommendation, treatment preferences did not differ considerably between hospital sites.</p> Conclusions <p>In prototypical case vignettes without evidence-based guideline recommendations, pronounced heterogeneity of treatment preferences between centers was found. Reconstructing these treatment preferences can contribute to enhancing the quality of evidence derived from observational studies. This seems especially important in the context of clinical questions that cannot be assessed in randomized trials; clinical routine data represent an adequate resource for evidence generation in these scenarios.</p> Trial registration <p>After conducting this study, the main study was registered in the German Clinical Trials Register (DRKS) on October 4, 2024 under study No. DRKS00034650.</p>

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Heterogeneity of treatment preferences in the absence of guideline recommendations – a case vignette study in colorectal cancer tumor boards in Germany, Austria and Switzerland

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月7日

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  • Johannes Soff,
  • Stefan Rolf Benz,
  • Christoph Kowalski,
  • Judith Hansinger,
  • Michael Gerken,
  • Daniel Maier,
  • Soo-Zin Kim-Wanner,
  • Jacqueline Witzmann,
  • Anke Reinacher-Schick,
  • Christian Peter Pox,
  • Kees Kleihues-van Tol,
  • Bianca Franke,
  • Olaf Schoffer,
  • Jochen Schmitt,
  • Monika Klinkhammer-Schalke,
  • Vinzenz Völkel,
  • Khalid Abnaof,
  • Fabian Baum,
  • Jochen Behringer,
  • Stefan Benz,
  • Melanie Börries,
  • Alicia Böttcher,
  • Sebastian Dieng,
  • Ian Erhard,
  • Fabienne Fox,
  • Bianca Franke,
  • Michael Gerken,
  • Alexander Götze,
  • Dennis Grimm,
  • Svenja Hahn,
  • Judith Hansinger,
  • Philipp Heinrich,
  • Peter Hellmund,
  • Evelin Horvath,
  • Soo-Zin Kim-Wanner,
  • Florian Kirsch,
  • Renate Kirschner-Schwabe,
  • Kees Kleihues-van Tol,
  • Monika Klinkhammer-Schalke,
  • Christoph Kowalski,
  • Christopher Krolla,
  • Annika Kuscher,
  • Tobias Kussel,
  • Martin Lablans,
  • Sabine Lang,
  • Daniel Maier,
  • Ralf Mertes,
  • Maria Neubert,
  • Antje Niedostatek,
  • Luis Pauler,
  • Anne Pelz,
  • Christian Peter Pox,
  • Daniela Reil,
  • Anke Reinacher-Schick,
  • Jochen Schmitt,
  • Constanze Schneider,
  • Olaf Schoffer,
  • Johannes Soff,
  • Jörg Janne Vehreschild,
  • Vinzenz Völkel,
  • Alexander Wanner,
  • Jacqueline Witzmann,
  • Sylke Zeißig

摘要

Background

For the treatment of colorectal cancer, the S3-Guideline of the German Guideline Program in Oncology supports clinical decision-making. Centers certified by the German Cancer Society are required to implement the guideline recommendations as comprehensively as possible. When guidelines provide insufficient or ambiguous evidence, heterogeneity of treatment preferences is likely to emerge across individual centers. The aim of this study is to describe the preferences of the centers’ tumor boards for treatment decisions when clear, evidence-based guideline recommendations are lacking.

Methods

To investigate the tumor boards’ preferences for different treatment options, an anonymous online survey was conducted among 314 certified colorectal cancer centers. The survey included seven visceral oncological and nine visceral surgical case vignettes. Centers were asked to discuss the vignettes in the tumor board or, alternatively, delegate them to an appropriate physician representatively speaking for the tumor board. The responses were analyzed descriptively and normalized entropy estimates (NE) were calculated for each vignette.

Results

A total of 123 centers (39%) responded to the survey. For oncological cases without clear guideline recommendations, substantial heterogeneity (NE: 0.39–0.71) in treatment preferences was observed. For instance, opinions varied widely for UICC II pT4a colon cancer. In this situation, 28% of centers would prefer fluoropyrimidine monotherapy, 39% oxaliplatin-based combination therapy and 33% no adjuvant chemotherapy at all. Surgical vignettes showed a preference for laparoscopic and robotic approaches, with variations based on tumor location (NE: 0.46–0.67). Importantly, in case of a clear evidence-based guideline recommendation, treatment preferences did not differ considerably between hospital sites.

Conclusions

In prototypical case vignettes without evidence-based guideline recommendations, pronounced heterogeneity of treatment preferences between centers was found. Reconstructing these treatment preferences can contribute to enhancing the quality of evidence derived from observational studies. This seems especially important in the context of clinical questions that cannot be assessed in randomized trials; clinical routine data represent an adequate resource for evidence generation in these scenarios.

Trial registration

After conducting this study, the main study was registered in the German Clinical Trials Register (DRKS) on October 4, 2024 under study No. DRKS00034650.