Purpose and Scope
The rising incidence of Glioblastoma (GBM) has been a debated issue within the medical community with conflicting evidence of increases or lack thereof in North America, Europe and Asia (Ostrom et al., 2018; Lee et al., 2010; Gousias et al., 2009; Phillips et al., 2018; Phonegate, 2019; Korja et al., 2019; Grech et al., 2020). One presiding belief in explaining this increased incidence however is overdiagnosis of GBM by clinicians (Ostrom et al., 2014). Of note, a personal analysis of the incidence of primary GBM in the US exhibited a prominent plateau and fall from 2016 to 2017. This time period coincides with the 2016 WHO update of central nervous system tumor classifications (Louis et al., 2016). Within the update, molecular testing for classification and clearer guidelines for delineating GBM from similar malignancies were introduced. To evaluate the potential role the 2016 WHO update on brain tumor classifications had on clinician decision making for GBM, the following survey was developed.
The survey will target neuropathologists as they are the primary entity responsible for following WHO classification criteria and diagnosing GBM malignancies. In specific, participating neuropathologists will have had clinical practices both before and after the 2016 WHO update to ensure existences of decision making comparisons. Surveys will be administered through Qualtrics to members from the American Association of Neuropathologists, European Confederation of Neuropathological Societies, Asian Society of Neuropathology and The International Society of Neuropathology by random selection virtually. To acknowledge however, we anticipate the international nature of the survey may lead to language barriers of survey implementation, causing disproportionate representation of groups where English is commonly spoken. Moreover, as administration through professional societies will have higher representation of clinicians from academic centers, we may have poorer participation from clinicians at community and private practices.
Survey Link
https://osu.az1.qualtrics.com/jfe/form/SV_50FnPCNdF9u8fTD
Reflection
We first evaluated the literature for existing surveys which assay the same construct. From there, we utilized elements from Aldape et al. 2017 survey evaluating the neuro-oncology communities’ perception of integrating molecular markers into WHO classification and Myers et al. 2016 survey of physician receptivity to molecular testing and readiness to act on results in colon cancer. Finally, the remainder of the survey was novel elements.
An initial three items was given to assess participation using a yes/no scale with branching logic. From there, the primary construct we evaluated was physician clinical decision making. We analyzed dimensions of clinician characteristics, adoption of WHO updates and changes to clinical workflow. Within this our measure/scale/instrument was the perceptions and changes that accompanied the update. For clinician characteristics, these items had a scale focused on defining aspects of one’s clinical environment. Adoption of updates utilized a Likert scale which ranged from strongly disagree to strongly agree. Finally, changes to workflow involved a 3-point measurement scale to state increases, decreases or no change in activity.
To assess the quality, it was important to evaluate how well our measures capture the construct and if findings can be generalized. Some methods to consider are having respondents match items to the definitions we are attempting to define and the degree it is matched. Furthermore we may perform factor analysis to understand if the variables we measure are highly similar or different amongst each other. Finally, clinician characteristics were used to assess if over-representation of groups occurred.
References
Aldape, K., Nejad, R., Louis, D. N., & Zadeh, G. (2017). Integrating molecular markers into the World Health Organization classification of CNS tumors: A survey of the neuro-oncology community. Neuro-Oncology, 19(3), 336–344. https://doi.org/10.1093/neuonc/now181
Gousias, K., Markou, M., Voulgaris, S., Goussia, A., Voulgari, P., Bai, M., Polyzoidis, K., Kyritsis, A., & Alamanos, Y. (2009). Descriptive Epidemiology of Cerebral Gliomas in Northwest Greece and Study of Potential Predisposing Factors, 2005–2007. Neuroepidemiology, 33(2), 89–95. https://doi.org/10.1159/000222090
Grech N, Dalli T, Mizzi S, Meilak L, Calleja N, & Zrinzo A. (2020). Rising Incidence of Glioblastoma Multiforme in a Well-Defined Population. Cureus, 12(5). https://www.cureus.com/articles/31024-rising-incidence-of-glioblastoma-multiforme-in-a-well-defined-population
Korja, M., Raj, R., Seppä, K., Luostarinen, T., Malila, N., Seppälä, M., Mäenpää, H., & Pitkäniemi, J. (2019). Glioblastoma survival is improving despite increasing incidence rates: A nationwide study between 2000 and 2013 in Finland. Neuro-Oncology, 21(3), 370–379. https://doi.org/10.1093/neuonc/noy164
Lee, C. H., Jung, K. W., Yoo, H., Park, S., & Lee, S. H. (2010). Epidemiology of Primary Brain and Central Nervous System Tumors in Korea. Journal of Korean Neurosurgical Society, 48(2), 145–152. https://doi.org/2010.48.2.145
Ostrom, Q. T., Bauchet, L., Davis, F. G., Deltour, I., Fisher, J. L., Langer, C. E., Pekmezci, M., Schwartzbaum, J. A., Turner, M. C., Walsh, K. M., Wrensch, M. R., & Barnholtz-Sloan, J. S. (2014). The epidemiology of glioma in adults: A “state of the science” review. Neuro-Oncology, 16(7), 896–913. https://doi.org/10.1093/neuonc/nou087
Ostrom, Q. T., Gittleman, H., Truitt, G., Boscia, A., Kruchko, C., & Barnholtz-Sloan, J. S. (2018). CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2011-2015. Neuro-Oncology, 20(suppl_4), iv1–iv86. https://doi.org/10.1093/neuonc/noy131
Philips, A., Henshaw, D. L., Lamburn, G., & O’Carroll, M. J. (2018a). Brain Tumours: Rise in Glioblastoma Multiforme Incidence in England 1995–2015 Suggests an Adverse Environmental or Lifestyle Factor. Journal of Environmental and Public Health, 2018, e7910754. https://doi.org/10.1155/2018/7910754
Phonegate, E. (2019, November 18). [Press release] Brain cancers: 4 times more new cases of glioblastoma in 2018 according to Public Health France. Phonegate Alert. https://www.phonegatealert.org/en/press-release-brain-cancers-4-times-more-new-cases-of-glioblastoma-in-2018-according-to-public-health-france