Idiopathic Inflammatory Myopathies and Malignancy Screening: A Survey of the Current Practices Amongst Canadian Neurologists and Rheumatologists
Maria Jekielek1, Rosane Nisenbaum2, Ophir Vinik3, Charles Kassardjian4
1St. Michael's Hospital, Division of Neurology, 2St. Michael's Hospital, 3St. Michael's Hospital, Division of Rheumatology, 4St. Michael's Hospital - Clinical Neurophysiology
Objective:
To better understand and characterize the current gaps and uncertainties amongst neurologists and rheumatologists in Canada with regards to malignancy screening in patients with idiopathic inflammatory myopathies (IIM).
Background:
There is a well-established association between IIM and underlying malignancy. Amongst IIM patients, the need for malignancy screening is generally accepted, however there are no evidence-based guidelines amongst neurologists and rheumatologists to guide clinicians on the choice and timing of investigations.
Design/Methods:
An online survey was created using Microsoft Office Forms consisting of 18 multiple-choice questions related to IIM malignancy screening practice. The survey contained questions pertaining to respondent characteristics, malignancy screening practices and concerns surrounding these practices. The survey was distributed to adult neurologists and rheumatologists in Canada through several local and country-wide neurology and rheumatology organizations. Quantitative and descriptive analysis of the data was performed using Excel and statistical software programs.
Results:
There were 68 respondents. Majority of respondents (96%) performed malignancy screening, however there was variability in many aspects of practice including delegation and choice of screening tests, influence of patient-specific factors, and time and length of repeat testing. Only 18% of respondents were confident in their malignancy screening practices. The most significant perceived knowledge gap was lack of consensus or guidelines on choice and frequency of malignancy screening. Between neurologists and rheumatologists, there were differences in the number of IIM patients seen, consideration of patient-specific factors and choice of screening investigations.
Conclusions:
Variability and knowledge gaps exist amongst neurologists and rheumatologists with regards to malignancy screening in IIM patients, especially timing and need for repeat screening. There is a lack of consensus and confidence in the choice and timing of these investigations, with neurologists and rheumatologists differing in their approach to malignancy screening. Further research is required to better understand the relationship between IIM and malignancy to create expert-led consensus guidelines.