Objective: To assess pulmonologists’ use, training in
the use, and knowledge base of the drug cyclophosphamide.
Design: Survey through questionnaire. Testing of knowledge
base before and after instructional conference.
and methods: Pulmonologists (94 attendings, 31 fellows), selected
randomly at the 1996 and 1997 annual meetings of The American Thoracic
Society, completed surveys of their use and training in the use of
cyclophosphamide. Thirty-five attending at the 1998 meeting completed a
test of knowledge base of the drug. Members of the pulmonary teaching
service at The University of Chicago Hospitals completed the test
before and after a case-based conference designed to educate
pulmonologists in the use of the drug.
Forty-three percent of the attending pulmonologists and 55% of the
fellows were currently using the drug in the management of their
patients; 77% of the attending pulmonologists had prescribed the drug
in the past. Nonmalignant diseases for which the drug was prescribed
included usual interstitial pneumonitis/desquamative interstitial
pneumonitis, vasculitis, collagen vascular disease, constrictive
bronchiolitis, sarcoid, and Goodpasture’s disease. Sixty-eight percent
of attending pulmonologists and 81% of fellows had no training in the
drug’s use. Of the attending pulmonologists who made use of the drug,
64% were prescribing and managing its use themselves. Of those who
prescribed and managed the drug’s use themselves, 65% had had no
training in its use. Of those fellows who prescribed and managed the
drug’s use themselves, 73% had had no training in the drug’s use. On
knowledge-based testing, the average correct score was 30 ± 10%.
With an educational conference, average pre- and post-test scores rose
from 40 ± 10% to 80 ± 10% (p < 0.001).
Conclusion: Cyclophosphamide had been used by the vast
majority of pulmonologists, either currently or in the past, for a wide
variety of lung diseases. Its use is commonly managed by physicians who
have no specific training relevant to this agent. Practitioner
knowledge base of the drug is poor, and case-based conferences in
fellowship may be an effective means of imparting information
concerning this drug.