Residents’ understanding of cancer prognosis: Does the level of training or oncology rotation experience affect residents’ perception of cancer prognosis?

e21033 Background: Over the last decade, immunotherapy has become a first-line therapy option alongside chemotherapy for certain cancers, providing durable responses. There is growing evidence suggesting that residents underestimate cancer prognosis, which can impact goals of care discussions and potentially lead to inappropriate treatment decisions. It is unclear whether the understanding of cancer prognosis among internal medicine (IM) residents is influenced by training experience. This study aims to evaluate whether the number of years of internal medicine residency training or prior oncology experience affects residents' ability to accurately estimate overall survival (OS) and progression-free survival (PFS) in patients with cancer. Methods: We conducted a cross-sectional study to assess categorical internal medicine residents' estimates on median OS or PFS of five different cancer patient scenarios. All scenario patients were identified as 50 years old and fully active, with no restrictions on their performance status. All categorical IM residents from the Northside Hospital Gwinnett IM residency program in Lawrenceville, Georgia were invited via email to complete an online survey created using SurveyMonkey. Residents were asked their PGY status and if they had any prior experience from oncology rotations. Results: Of 44 surveys sent, 41 were completed (93.2%). This included 13 PGY-1s, 14 PGY-2s, and 14 PGY-3s. We found that PGY-1 residents correctly estimated the prognosis in 26.2% of the patient case scenarios, compared to 24.3% for PGY-2 residents and 25.7% for PGY-3 residents. The distribution of responses (correct, underestimated, overestimated) was not significantly different between each of the classes (p = 0.8348). Overall, and consistently across all subgroups, residents tend to underestimate median OS of cancer patients. Additionally, the distribution of responses (correct, underestimated, overestimated) from those with prior oncology rotations was not significantly different compared to the distribution of responses from those who have not had oncology rotations (p = 0.6304). Conclusions: In this IM residency program at a large community hospital, more years of training or additional rotations in oncology did not significantly change residents' knowledge or perspective of prognosis in various common oncology scenarios. Improving awareness of advancements in novel cancer agents via a standardized curriculum may be necessary to enhance residents' prognostic accuracy at all levels so that patient care is optimized. Distribution of responses among residents. PGY1 PGY2 PGY3 Oncology Rotation All Residents Avg % Correct 26.2 24.3 25.7 30 25.3 Avg % Under 69.2 65.7 67.1 60 67.3 Avg % Over 4.6 10.0 7.1 10 7.3