C110-24 Pulmonologists’ Knowledge and Practices in Small Cell Lung Cancer

Abstract Rationale Small cell lung cancer (SCLC) is an aggressive malignancy with worse survival compared to non-small cell histologies. In light of the first advances in front-line therapy in decades, we undertook this study to characterize pulmonologists’ knowledge and practices for diagnosis and treatment of SCLC. Methods Pulmonologists in the CHEST Analytics database were invited to participate in a 27-item survey focusing on diagnosis and management of SCLC. The survey was piloted by 11 pulmonology faculty and fellows and amended prior to distribution in July 2025. Participants were practicing pulmonologists diagnosing 1 lung cancer per month on average. Results Four hundred pulmonologists completed the survey and most (72%) practiced in community settings. Pulmonologists identified extensive disease with more accuracy and more certainty than limited-stage disease (Figure). Only 28% responded they were very confident in their ability to delineate limited from extensive stages. Pulmonologists identified their specialty as leading bronchoscopy for tissue sampling 97% of the time, ordering PET 87%, ordering MRI brain 70%, and deciding on hospice vs treatment 34% of the time. Pulmonologists were likely to expedite diagnostic activities (89%), most commonly urgently ordering of PET/CT (75%) or communicating urgency to patient/family (74%), and least likely to present at tumor board (46%) or communicate with radiation oncologists (29%). Only 12% and 17% were very familiar with indications for immunotherapy in limited and extensive stage SCLC, respectively. Most (84%) felt that treatment improved quality of life in limited-stage and less so (60%) in extensive-stage disease. The most common reasons for non-referral to oncology included the patient deferring treatment (75%) and lack of family support (31%). There were indications of treatment nihilism with only half strongly agreeing their interventions impact survivorship and 63% indicating the side effects from treatment may be worse than the disease. Further, about one-third indicated patient actions have little impact on survivorship and 43% suggest luck may drive survival. Conclusions There are gaps in pulmonologists’ knowledge and confidence for attributing stage with some deferring portions of staging to oncology. Despite the role radiation oncology plays in determining eligibility for limited-stage treatment, discussions with radiation oncologists and tumor board presentation were uncommon steps to expedite care. Knowledge gaps also existed for treatment, particularly immunotherapy indications and potential to improve quality of life and survival. Finally, there were signals of treatment-related nihilism, likely in-part due to SCLC’s aggressive nature and decades stagnation in front-line treatments. This abstract is funded by: CHEST, Astra Zeneca