Systemic Therapy Utilization Patterns among US Dermatologists and Oncologists Treating Cutaneous T-Cell Lymphoma

Background: Several systemic therapies are available for patients with cutaneous T-cell lymphoma (CTCL). However, little is known about physicians’ familiarity with and utilization of these therapies. To address this issue, we conducted a web-based survey among physicians treating CTCL with systemic therapies in the United States.

Methods: We surveyed a geographically representative panel of dermatologists and oncologists in September 2007. Physicians had to have treated at least one CTCL patient systemically over the past two years and been practicing medicine for >2 years. Individual systemic therapies were grouped according to NCCN guidelines as Category A (ECP, bexarotene, denileukin diftitox, interferon, vorinostat, and methotrexate) or Category B therapies (gemcitabine, CHOP, and doxorubicin). Chi-square or Fisher’s exact tests assessed statistical differences between specialties.

Results: A total of 250 physicians participated; 128 dermatologists and 122 oncologists. Mean age was 47.5 (std =9.9) years and 20.0% were female. Significantly more (p < 0.0001) dermatologists than oncologists reported being not or somewhat familiar with denileukin diftitox (49.2% vs. 14.8%), gemcitabine (71.1% vs.7.4%), doxorubicin (57.8% vs. 5.7%), CHOP (33.6% vs. 1.6%) and vorinostat (67.2% vs. 36.9%). Overall, use of Category A therapies decreased in later stage disease while use of Category B therapies increased. Dermatologists chose Category A therapies and referred patients more frequently, whereas oncologists chose Category B therapies and referred less frequently.

Conclusions: Familiarity with and utilization of systemic therapies for CTCL differ by physician specialty. Educational efforts aimed at highlighting advances in CTCL treatment and newly implemented treatment guidelines may help optimize patient care.