OBJECTIVES : Recent improvements in the treatment of non-small cell lung cancer (NSCLC) are largely attributable to early detection, refinements in radiation and surgical techniques, and personalized targeted therapy in patients with oncogenic driver mutations. Accordingly, multidisciplinary collaboration and biomarker testing have become critically important. This study was conducted to identify key specialties involved and describe different roles in the management of NSCLC in Korea.

METHODS : A doctor level cross-sectional survey was conducted with 468 panels in 2019, randomly selected considering a balanced distribution in specialties, regions and institutions. The survey included questions around physicians’ involvement in diagnosis and treatment of cancer. Based on the survey, the number of NSCLC patients they treated, stratified by cancer stage and drug treatment, and the types of biomarker tests, were compared by specialty.

RESULTS : Among the surveyed panels, 59 specialists reported treating NSCLC, consisting of 33 pulmonologists, 19 onc-haematologists, and 7 in other specialties. The number of NSCLC patients treated per month averaged 89.12±75.82, 40.84±49.27, and 27.57±33.79 (p=0.002) for pulmonologists, onc-haematologists, and other specialists, respectively; of those NSCLC patients they treated, 70.93%, 81.70%, and 40.93% (p<0.001) were late stage, and 64.57%, 64.95%, and 49.74% (p<0.001) received drug treatment, respectively. Onc-haematologists performed the most biomarker tests (4.53±1.93), followed by other specialists (3.57±2.15) and pulmonologists (3.45±0.94). Most of the pulmonologists tested mutations in ALK (100%), EGFR (100%), and PL-1/PD-L1 (96.97%), but few other biomarkers were tested. All onc-haematologists tested mutations in ALK (100%), EGFR (100%), and PL-1/PD-L1 (100%), and some in BRAF (47.37%) and KRAS (36.84%) additionally. Other specialists tested less for ALK (42.86%), EGFR (85.71%), and PL-1/PD-L1 (57.14%) mutation, but more for KRAS (71.43%) and VEGF (57.14%).

CONCLUSIONS : Our study suggests that the roles and practices differ in the management of NSCLC by specialty. Further study is needed to reflect patients’ specific medical condition.