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Oct 2, 2013 (3 years and 8 months ago)

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Supplementary Table 1
. Factors that limit the current use of molecular tests for the management of patients with cancer in New
Zealand.




Clinicians who manage breast cancer

(n = 94)
a


Clinicians who manage AML

(n = 26)
b


Clinicians who prescribe chemotherapy

(n = 34)
c



Onco
type

DX
®


MammaPrint
®


FLT3

mutation
analysis


NPM1

mutation
analysis


CEBPA
mutation
analysis


KRAS
mutation
analysis


UGT1A1

mutation
analysis


EGFR
mutation
analysis



Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used



(n = 10)

(n = 84)


(n = 4)

(n = 90)


(n = 22)

(n = 4)


(n = 18)

(n = 8)


(n = 3)

(n = 23)


(n = 16)

(n = 18)


(n =
2
)

(n =
32
)


(n =

7
)

(n =
27
)

No limiting
factor(s)
identified

0

(0)

0

(0)


0

(0)

4

(4)


14

(64)

0

(0)


8

(44)

2

(25)


3

(100)

5

(22)


1

(6)

0

(0)


2

(100)

1

(3)


1

(14)

3

(11)

Not aware of the
tool

-


25

(30)


-


19

(21)


-


2

(50)


-


6

(75)


-


6

(26)


-


10

(56)


-


16

(50)


-


7

(26)

Other limiting
factor identified

10

(100)

59

(70)


4

(100)

67

(75)


8

(36)

2

(50)


10

(66)

0

(0)


0

(0)

12

(52)


15

(94)

8

(44)


0

(0)

15

(47)


6

(86)

17

(63)

Limiting factors:









































Cost
d

9


36



3


41



3


0



2







15



14


5





10



6


8



Time

1


2



1


2



1


0



1







0



0


0





1



0


0



Not relevant
to my practice

0


17



0


20



0


1



0







3



1


3





0



0


7



Concern about
evidence base

1


13



0


11



1


0



1







1



0


0





1



1


2



Doesn’t add
information

0


6



0


6



0


1



0







2



0


0





4



0


1



Limited
availability
e

-


9



-


7



-


-



0







6



4


1





4



-


2



Patient age
f

-


-



-


-



5


-



4







-



-


-





-



-


-



Medicolegal
concerns

0


3



0


3



0


0



0







0



0


0





0



0


0



Other

2


0



0


4



1


0



3
g







1



0


0





0



0


2



a
Responses for Onco
type

DX
®

and MammaPrint
®

are from clinicians who manage patients
with breast cancer (n = 94),

b
responses for
FLT3
, NPM1
and CEBPA

mutation analysis

are

from clinicians who manage a
cute myeloid
leukaemia (n = 26),

c
responses
for
KRAS
, UGT1A1
and
CEBPA

mutation analysis

are

from clinicians
who
prescribe chemotherapy (n = 34).

d
cost of the test to the patient or the health system,
e
availability of the test

or ,in the
case of
KRAS

testing, lack of access to /availability of cetuximab (not funded in the public health system at time of survey),
f
Test not used for older patients for whom certain management
strategies would not be offered,
g
data
regarding facto
rs limiting use of
NPM1

amongst previous users was not collected due to a questionnaire programming error.


= response not offered
. Current use was defined as within the 6 months prior to completing the
questionnaire.
More than one limiting factor could b
e selected for each tool or test by each respondent. Data are number of participants (percentage).



Supplementary Table 2
. Factors that limit the current use of computerised prognostic tools for the management of patients with
cancer in New Zealand.




Adjuvant! for breast
cancer
a


Adjuvant! for colon
cancer
a


Adjuvant! for lung
cancer
a


ACPGBI Colorectal
Cancer Model
b


MSKCC
prediction
tools
c


IBTR!
d



Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current /
previous
user

Never
used


Current user


Current user



(n = 70)

(n = 24)


(n = 25)

(n = 64)


(n = 10)

(n = 31)


(n = 1)

(n = 88)


(n = 4)


(n = 1)

No limiting
factor(s)
identified

24

(34)

0

(0)


12

(48)

2

(33)


7

(70)

3

(10)


1

(100)

2

(2)


0

(0)


1

(100)

Not aware of the
tool

-


13

(54)


-


41

(64)


-


13

(42)


0

(0)

84

(96)


-



-


Other limiting
factor identified

46

(66)

11

(46)


13

(52)

21

(33)


3

(30)

15

(48)


0

(0)

2

(2)


4

(100)


0

(0)

Limiting factors:





















0






Time

24


1



7


4



0


1





0



3






Not relevant
to my practice

2


7



3


12



1


8





0



0






Internet
access
e

16


1



10


2



1


0





0



1






Concern about
evidence base

16


0



4


3



3


3





0



0






Doesn’t add
information

7


1



4


3



3


2





2



0






Medicolegal
concerns

3


0



1


0



0







0



0






Other

6


3



2


2



0


1





1



1






a
www.adjuvantonline.com
,
b
www.riskprediction.org.uk
,
c
www.nomograms.org
,
d
http://160.109.101.132/ibtr,
e
limited internet access in clinical settings
,

MSKCC = Memorial Sloan
-
Kettering Cancer Center, ACPGBI = Association of Coloproctology of Great Britain and Ireland.

Resp
onses for Adjuvant! for breast cancer are from clinicians who manage patients with breast cancer (n = 94); for Adjuvant!
for colon cancer and ACPGBI
colorectal cancer
model clinicians who manage colon cancer(n = 89
)
.
Current use was defined as within 6 mon
ths prior to completing the questionnaire.
MSKCC
and IBTR! were identified by participants as ‘other’ prognostic models which they use


there are therefore no data from clinicians who have previously or never
used these tool.

More than one limiting factor

could be selected for each tool or test by each respondent.


= response not offered. Data are number of participants (percentage).


Supplementary Table 3
. Current impact of molecular tests on the management of patients with cancer in New Zealand
.





O
nco
type

DX
®


MammaPrint
®


FLT3

mutation
analysis


NPM1

mutation
analysis


CEBPA
mutation
analysis


KRAS
mutation
analysis


UGT1A1

mutation
analysis


EGFR
mutation
analysis




(n = 6)


(n = 2)

(n = 22)


(
n = 15)


(n = 2)


(n = 12)


(n = 1)


(n = 3)

How
often have you used this
tool/test in the last 6
months?


1.5

(1
-
2)


3.5



3

(2
-
3)


3

(3
-
4)


3



5

(3
-
6)


1



2


For what proportion of eligible
patients do you use this
tool/test?


5

(5
-
6)


10



90

(63
-
95)


75

(50
-
90)


60



23

(5
-
95)


95



5


What is the primary function
of this tool/test in your
practice?


























Explaining management
options


1

(17)


1

(50)


3

(14)


2

(13)


0

(0)


5

(42)


0



0



Clinical decision making


4

(66)


1

(50)


17

(77)


13

(87)


2

(100)


2

(16)


1



2



Other


1

(17)
a


0



2

(9)
b


0



0

(0)


5

(42)
b


0



1
b


Does this test

affect your
clinical decisions?


























Yes


3

(50)


2

(100)


19

(90)


11

(73)


1

(50)


10

(8)


0



2



No


0



0



2

(5)


2

(13)


1

(50)


1

(84)


1



1



Other


3

(50)


0



1

(5)


2

(13)


0

(50)


1

(8)


0



0


How does this tool/test

affect
your clinical decisions?




























Less often offer
chemotherapy

1


Less often offer
chemotherapy

0


More often offer
stem cell
transplantation

1
6


More often offer
stem cell
transplantation

0


More often offer
stem cell
transplantation

1


Less

often offer
cetuximab


6





Less

often
EGFR
-
tyrosine kinase
inhibitors


1




More often offer
chemotherapy

2


More often offer
chemotherapy

2


More often offer
chemotherapy

1


More often offer
chemotherapy

6


More often offer
chemotherapy

0


More often offer
cetuximab

2





More

often
EGFR
-
tyrosine kinase
inhibitors


1










More often offer
deferment of
treatment

2


More often offer
deferment of
treatment

5


More often offer
deferment of
treatment

0


Determines trail
eligibility

2







Does use of this tool/test
improve patient outcomes in
your practice?
a



Yes


3

(50)


-



43

(73)


12

(80)


2

(100)


8

(67)


1



2



No


0



-



7

(12)


1

(7)


0

(0)


1

(8)


0



0



Don’t know


3

(50)


-



9

(15)


2

(13)


0

(0)


3

(25)


0



1



Responses from clinicians who currently use these
molecular tests; current use was defined
as within 6 months prior to completing the questionnaire

Data on u
se of t
ools and proportion of patients are
median (interquartile range). All other data are
number of respondents (percentage).

a
Used in a clinical trail setting.
b
Used to assess eligibility

to enter a clinical trail.
-

= no answers available for this question.




S
upplementary Table 4
.
Current impact of computerised prognostic tools on the management of patients with cancer in New Zealand.





Adjuvant! for breast
cancer
a


Adjuvant! for
colon

cancer
a


Adjuvant! for
lung

cancer
a


MSKCC prediction tools
b


ACPGBI Colorectal
Cancer Model
c


IBTR!
d




(n = 59)


(n = 21
)


(n =
4
)


(n

=

4)


(n =

1
)


(n =

1
)

How often have you used this
tool/test in the last 6 months?


12

(7
-
35)


6

(5
-
12)


3

(2
-
5)


8

(5
-
13)


4



10


For what proportion of eligible
patients do you use this
tool/test?


85

(45
-
95)


90

(50
-
95)


63

(48
-
73)


15

(9
-
22)


10



30


What is the primary function of
this tool/test in your practice?




















Explaining
management options


42

(71)


16

(76)


3

(75)


2

(50)


0



1



Clinical decision
making


16

(27)


3

(14)


1

(25)


2

(50)


1



0



Other


1

(2)


2

(10)


0

(0)


0



0



0


Does this tool/test affect your
clinical decisions?




















Yes


28

(48)


5

(24)


1

(25)


2

(50)


1



0



No


22

(37)


14

(66)


3

(75)


1

(25)


0



1



Other


9

(15)


2

(10)


0

(0)


1

(25)


0



0


How does this tool/test affect
your clinical decisions?






















Less often offer
chemotherapy

18


Less

often offer
chemotherapy

3


Less often offer
chemotherapy

0


Less often offer
chemotherapy

1


Less often offer
surgery

1







More often offer
chemotherapy

10


More often offer
chemotherapy

2


More often offer
chemotherapy

1


More often offer
chemotherapy

1


More often offer
surgery

0




Does use of this tool
improve
patient outcomes in your
practice?
e




















Yes


43

(73)


9

(43)


1

(25)


2

(50)


1



0



No


7

(12)


5

(24)


1

(25)


1

(25)


0



1



Don’t know


9

(15)


7

(33)


2

(50)


1

(25)


0



0



Responses from clinicians who currently use these computerised
prognostic tools
; current use was defined as within 6 months prior to completing the questionnaire
.
Data on u
se of t
ools and proportion of patients are
median
(
interquartile range). All other data are number of respondents (percentage).

a
www.adjuvantonline.com
,

b
www.nomograms.org
,

c
www.riskprediction.org.uk
,

d
http://160.109.101.132/ibtr/
,

e
Outcomes could include, for example,
reduction in side effects by avoiding treatment (e.g. allogeneic stem cell transplantation) as well as overall and disease fr
ee survival.

Questions about the A
djuvant! and ACPGBI tools were included in the original questionnaire, the
MSKCC and IBTR! tools were identified by participants as ‘other’ tools currently in use.
Participants who manage colorectal cancer were also questioned about their use of the St Mar
k’s Lymph Node Positivity Model
(
www.riskprediction.org.uk
)
-

no participants currently use this tool.



Supplementary figure 1.
I
nvitation to participate in an online questionnaire surveying use of
computerise prognostic tools and
molecular tests by clinicians treating patients with cancer in New Zealand.

































Supplement
ary Figure 2: Questionnaire to evaluate the current use of
and views on
computerised prognostic tools and molecular tests by specialist cancer clinicians in New
Zealand.

Information for participants and survey questions

Clinical Decision Support Systems and Molecular Tests in Cancer Care

We are investigating the current use of clinical decision support systems and molecular tests in
the management of cancer patients in New Zealand. Your participation in this survey would be very
helpful and much appreciated, even if the topic initially see
ms of limited relevance to your practice.

Be in to Win an iPad!







On completing this questionnaire you will have the opportunity to win a brand new iPad and
become one of the first people in New Zealand to own one! To enter the draw complete y
our contact
details at the end of the questionnaire (we'll keep these details confidential and separate to your
questionnaire

answers).

There are 185 questions in this survey

Information for Participants

Participants may withdraw from this study at any ti
me during completion of the questionnaire

Once you have submitted your answers we will not be able to identify you, and you will
therefore not be able to withdraw them.

Answers to this questionnaire, and data derived from it, will be stored for up to 6 yea
rs on
secure, password protected University of Auckland servers.

The identifying details required in order to enter the prize draw will be collected and stored
separately from the questionnaire ensuring that all data obtained in the questionnaire remains
a
nonymous. These details will be deleted as soon as the prize recipient has been drawn.

This is an interdisciplinary project from the Schools of Medicine, Population Health and Medical
Sciences, University of Auckland.

The researchers are:



Dr Deborah Wright
, General Surgical trainee/PhD student, Departments of
Surgery/Molecular Medicine & Pathology



A/Professor Cris Print, Department of Molecular Medicine & Pathology



Mr Arend Merrie, Colorectal Surgeon, Auckland Hospital



Dr Rob McNeill, Lecturer, School of Po
pulation Health.

Dr Deborah Wright is supported by funding from the Foundation for Surgery (Royal Australasian
College of Surgeons), Newmarket Rotary Charitable Foundation, and the Foundation for Research,
Science and Technology.

Any queries regarding this

study may be directed to:



Dr Deborah Wright, deborah.wright@auckland.ac.nz, 09 373
-
7599 extn. 89536



A/Professor Cris Print, c.print@auckland.ac.nz, 09 373
-
7599 extn. 85062




Professor Peter Browett, Head of Department, Department of Molecular Medicine &
Pat
hology, p.browett@auckland.ac.nz, 09 373
-
7599 extn. 86281

For any queries regarding ethical concerns you may contact:



Chair, The University of Auckland Human Participants Ethics Committee, The University
of Auckland, Office of the Vice Chancellor, Private
Bag 92019, Auckland 1142. Telephone
09 373
-
7599 extn. 83711.

Approved by the University of Auckland Human Participants Ethics Committee on 21st April
2010 for (3) years, Reference Number 2010 / 147.

Participant Eligibility

Are you a clinician involved in
the management of solid organ or haematological malignancy who is
currently practicing in New Zealand?

Please choose only one of the following


Yes

No

Thank you very much for your interest in our questionnaire.

However it is designed to survey clinicians
involved in the management of patients with solid organ
and haematological malignancy who are currently practicing in New Zealand.

Please exit by closing this window in your browser.

Only answer this question if the following conditions are met:

Answer was

'No' at question '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

The questionnaire starts on the following page.

Please note that a * before the question indi
cates that it is mandatory, you will not be able to
proceed to the next question without answering it. If you chose the answer option 'other' please
provide more details where there is a text box provided.

Only answer this question if the following conditi
ons are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Section 1: C
linical Decision Support Systems

Clinical decision suppor
t systems are interactive computer
-
based tools that help us to integrate data
when making patient
-
specific management decisions.

In this section we aim to discover how many clinicians currently use clinical decision support
systems during the management of

patients with cancer, what they are used for, and whether there
factors which limit their uptake.

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Which, if any, of the following have you previously heard of? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a c
linician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Please choose all that apply:



Adjuvant! for Breast Cancer (www.adjuvantonline.com)



Adjuvant! for Lung Cancer (www.adjuvantonline.c
om



Adjuvant! for Colon Cancer (www.adjuvantonline.com)



ACPGBI Colorectal Cancer Model (www.riskprediction.org.uk)



St. Mark's Lymph Node Positivity Model (www.riskprediction.org.uk)



Other



I have not heard of any clinical decision support

Are you
involved in the management of patients with breast cancer? *


Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological malignancy who

is currently practicing in New Zealand?)

Please choose only one of the following


Yes

No

Do you use Adjuvant! for Breast Cancer? *

Only answer this question if the following conditions are met: Answer was at question '6 [.]' (Which, if any, of the follow
ing have you previously heard of?)
and Answer was 'Yes' at question '7 [1 BC ]' (Are you involved in the management of patients with breast cancer?)

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

How many tim
es have you used Adjuvant! for Breast Cancer in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'8 [2 BC]' (Do you use Adjuvant!
for Breast Cancer?)

You've to
ld us how many times you've used Adjuvant! for Breast Cancer over the last six months.
This will be influenced by the number of women with breast cancer that you manage. For what
percentage of your patients with resected, non metastatic breast cancer do y
ou use this tool?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'8 [2 BC]' (Do you use Adjuvant!
for Breast Cancer?)

What p
rimary function does using Adjuvant! for Breast Cancer serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'8 [2 BC]' (Do you use Adjuvant!
for Breast Cancer?)



Please

choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

Does using Adjuvant! for Breast Cancer affect your clinical decisions? *

Only answer this question if the follo
wing
conditions

are met: Answer was 'Currently (within the last 6 months)' at question '8 [2 BC]' (Do you use Adjuvant!
for Breast Cancer?)

Please choose only one of the following:



Yes
-

I refer FEWER patients to medical oncology or offer chemotherapy to FEWER
patients



Yes
-

I refer MORE patients to medical oncology or offer chemotherapy to MORE patients



No
-

it doesn't affect my clinical decisions



Other

Do you think that using
Adjuvant! for Breast Cancer improves patients' outcomes in your practice?
'Outcomes' may include, for example, reduction in side effects by avoiding treatment (e.g.
chemotherapy), as well as overall and disease free survival. *

Only answer this question if

the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '8 [2 BC]' (Do you use Adjuva
nt!
for Breast Cancer?)

Please choose only one of the following


Yes

No

Don’t know

Are there any factors which limit your use of
Adjuvant! for patients with breast cancer? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'8 [2 BC]' (Do you use Adjuvant!
for Breast Cancer?)

Please choose all that apply:




Tim
e pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which lim
it my use of Adjuvant! for Breast Cancer



Other:

&

Are there any factors which limit your use of Adjuvant! for patients with breast cancer? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '8 [2 BC]' (Do

you use Adjuvant! for Breast Cancer?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '7 [1 BC ]' (Are you involved in
the management of patients with
breast cancer?) and Answer was 'Never' at question '8 [2 BC]
' (Do you use Adjuvant! for Breast Cancer?)

Please choose all that apply:



I am not involved in making decisions about adjuvant therapy, this tool is not relevant to
my current practice



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which limit my use of Adjuvant! for Breast Cancer



Other

Are you involved in

the management of patients with non
-
small cell lung cancer? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological malignancy w
ho is currently practicing in New Zealand?)

Please choose only one of the following


Yes

No

Do you use Adjuvant! for Lung Cancer? *

Only answer this question if the following conditions are met: Answer was at question '6 [.]' (Which, if any, of the follow
ing have you previously heard of? )
and Answer was 'Yes' at question '17 [1 LC]' (Are involved in the management of patients with non
-
small cell lung cancer?)



Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never


H
ow many times have you used Adjuvant! for Lung Cancer in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'18 [2 LC ]' (Do you use
Adjuvant! for Lung Cancer?)

You've told us how many times you've used Adjuvant! for Lung Cancer over the last six months.
This will be influenced by the number of patients with NSCLC that you manage. For what
percentage of your patients with resected, non
-
metastatic NSCLC do you use
this tool?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'18 [2 LC ]' (Do you use
Adjuvant! for Lung Cancer?)

What primary
function does using Adjuvant! for Lung Cancer serve for you? *


Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'18 [2 LC ]' (Do you use
Adjuvant! for Lung Cancer?)



Please choose o
nly one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

Does using Adjuvant! for Lung Cancer affect your clinical decisions? *

Only answer this question if the following condit
ions are met: Answer was 'Currently (within the last 6 months)' at question '18 [2 LC ]' (Do you use
Adjuvant! for Lung Cancer?)

Please choose only one of the following:



Yes
-

I refer FEWER patients to medical oncology or offer chemotherapy to FEWER
patients



Yes
-

I refer MORE patients to medical oncology or offer chemotherapy to MORE patients



No
-

it doesn't affect my clinical decisions



Other

Do you think that using
Adjuvant! for Lung Cancer improves patients' outcomes in your practice?
'Outcomes' may include, for example, reduction in side effects by avoiding treatment (e.g.
chemotherapy), as well as overall and disease free survival. *

Only answer this question if t
he following conditions are met: Answer was 'Currently (within the last 6 months)' at question '18 [2 LC ]' (Do you use
Adjuvant! for Lung Cancer?)

Please choose only one of the following


Yes

No

Don’t know

Are there any factors which limit your use of Ad
juvant! for patients with lung cancer?*

Only answer this question if the following conditions are met:° Answer was 'Currently (within the last 6 months)' at question

'18 [2 LC ]' (Do you use
Adjuvant! for Lung Cancer?)

Please choose all that apply:



Time pr
essure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which limit m
y use of Adjuvant! for Lung Cancer



Other:

&

Are there any factors which limit your use of Adjuvant! for patients with lung cancer?*

Only answer this question if the following conditions are met: Answer was 'Previously' at question '18 [2 LC ]' (Do you use

Adjuvant! for Lung Cancer?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '17 [1 LC]' (Are involved in the
management of patients with
non
-
small cell lung cancer?) and Answer was 'Never' at question '18 [2 LC
]' (Do you use Adjuvant! for Lung Cancer?)

Please choose all that apply:



I am not involved in making decisions about adjuvant therapy, this tool is not relevant to
my current practice



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use




Don't think it adds to information available from other sources



No
-

there are no factors which limit my use of Adjuvant! for Lung Cancer



Other:

Are you involved in
the management of patients with colorectal cancer? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological malignancy who is curr
ently practicing in New Zealand?)

Please choose only one of the following


Yes

No

Do you use Adjuvant! for Colon Cancer? *

Only answer this question if the following conditions are met: Answer was at question '6 [.]' (Which, if any, of the followin
g have
you previously heard of? )
and Answer was 'Yes' at question '27 [1 CC]' (Are you involved in the management of patients with colorectal cancer?)

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

How many times h
ave you used Adjuvant! for Colon Cancer in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'28 [2 CC]' (Do you use Adjuvant!
for Colon Cancer?)

You've told us

how many times you've used Adjuvant! for Colon Cancer over the last six months.
This will be influenced by the number of patients with colon cancer that you manage. For what
percentage of your patients with resected, non
-
metastatic colon cancer do you use

this tool?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'28 [2 CC]' (Do you use Adjuvant!
for Colon Cancer?)

What primary

function does Adjuvant! for Colon Cancer serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'28 [2 CC]' (Do you use Adjuvant!
for Colon Cancer?)

Please choose only
one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

Does using Adjuvant! for Colon Cancer affect your clinical decisions? *

Only answer this question if the following
conditions are met: Answer was 'Currently (within the last 6 months)' at question '28 [2 CC]' (Do you use Adjuvant!
for Colon Cancer?)

Please choose only one of the following:



Yes
-

I refer FEWER patients to medical oncology or offer chemotherapy to FEWER
patients



Yes
-

I refer MORE patients to medical oncology or offer chemotherapy to MORE patients



No
-

it doesn't affect my clinical decisions



Other

Do you think that using Adjuvant! for Colon Cancer improves patients' outcome in your practice?
'Outcome
s' may include, for example, reduction in side effects by avoiding treatment (e.g.
chemotherapy), as well as overall and disease free survival. *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months
)' at question '28 [2 CC]' (Do you use Adjuvant!
for Colon Cancer?)

Please choose only one of the following


Yes

No

Don’t know


Are there any factors which limit your use of Adjuvant! for patients with colon cancer? *

Only answer this question if the follo
wing conditions are met: Answer was 'Currently (within the last 6 months)' at question '28 [2 CC]' (Do you use Adjuvant!
for Colon Cancer?)

Please choose all that apply:



Time pressure



Lack of adequate internet access in clinical settings



Concern about it
s evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which limit my use of Adjuvant! for Colon Cancer



Other:

&

Are there any factors which limit

your use of Adjuvant! for patients with colon cancer? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '28 [2 CC]' (Do you use Ad
juvant! for Colon Cancer?)

Only answer this question if the following cond
itions are met: Answer was 'Yes' at question '27 [1 CC]' (Are you involved in the management of patients with
colorectal cancer?) and Answer was 'Never' at question '28 [2 CC]' (Do you use Adjuvant! for Colon Cancer?)

Please choose all that apply:



I am not

involved in making decisions about adjuvant therapy, this tool is not relevant to
my current practice



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which limit my use of Adjuvant! for Colon Cancer



Other:

Do you use the ACPGBI Colorectal Cancer Mortality Mo
del? *

Only answer this question if the following conditions are met: Answer was at question '6 [.]' (Which, if any, of the followin
g have you previously heard of? )
and Answer was 'Yes' at question '27 [1 CC]' (Are you involved in the management of patien
ts with colorectal cancer?)

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

How many times have you used the ACPGBI Colorectal Cancer Model in the last 6 months? *

Only answer this question if the following co
nditions are met: Answer was 'Currently (within the last 6 months)' at question '37 [2 CRC]' (Do you use the
ACPGBI Colorectal Cancer Mortality Model?)

You've told us how many times you've the ACPGBI Colorectal Cancer Model over the last six months.
This w
ill be influenced by the number of patients with colorectal cancer that you manage. For
what percentage of your patients with colorectal cancer do you use this tool?

Minimum 5% Maximum 95%*

Only answer this question if the followin
g conditions are met: Answer was 'Currently (within the last 6 months)' at question '37 [2 CRC]' (Do you use the
ACPGBI Colorectal Cancer Mortality Model?)

What primary function does using the ACPGBI Colorectal Cancer Mortality Model serve for you? *


Only
answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '37 [
2 CRC]' (Do you use the
ACPGBI Colorectal Cancer Mortality Model?)

Please choose only one of the following:



It helps me make clinic
al decisions



It helps me explain management options / decisions to my patients



Other

Does using the ACPGBI Colorectal Cancer Mortality Model affect your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Curr
ently (within the last 6 months)' at question '37 [2 CRC]' (Do you use the
ACPGBI Colorectal Cancer Mortality Model?)

Please choose only one of the following:



Yes
-

I refer FEWER patients to a surgeon or offer surgery to FEWER patients



Yes
-

I refer MORE patients to a surgeon or offer surgery to MORE patients



No
-

it doesn't affect my clinical decisions



Other

Do you think that using the ACPGBI Colorectal Cancer Mortality Model improves patients' outcomes
in your practice? 'Out
comes' may include, for example reduction in side effects by avoiding
treatment (e.g. surgery), as well as overall and disease free survival. *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)'

at question '37 [2 CRC]' (Do you use the
ACPGBI Colorectal Cancer Mortality Model?)

Please choose only one of the following


Yes

No

Don’t know

Are there any factors which limit your use of the ACPGBI Colorectal Cancer Mortality Model for
patients with co
lorectal cancer? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'37 [2 CRC]' (Do you use the
ACPGBI Colorectal Cancer Mortality Model?)

Please choose all that apply:



Time press
ure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which limit my u
se of the ACPGBI Colorectal Cancer Mortality
Model



Other:

&

Are there any factors which limit your use of the ACPGBI Colorectal Cancer Mortality Model for
patients with colorectal cancer? *

Only answer this question if the following conditions are met: Ans
wer was 'Previously' at question '37 [2 CRC]' (Do you use the ACPGBI Colorectal Cancer
Mortality Model?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '27 [1 CC]' (Are you involved in
the management of patients

with
colorectal cancer?) and Answer was 'Never' at question '37 [2 CRC]' (Do you use the ACPGBI Colorectal Cancer Mortality Model?
)

Please choose all that apply:



I am not involved in making decisions about surgery for colorectal cancer, this tool is not
r
elevant to my current practice.



Time pressure



Lack of adequate internet access in clinical settings




Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



No
-

there are no factors which limit my use of the ACPGBI Colorectal Cancer Mortality
Model



Other:

Do you use the St. Mark's Lymph Node Positivity Model? *

Only answer this question if the following conditions are met: Answer was at question '6 [.]' (Whi
ch, if any, of the following have you previously heard of? )
and Answer was 'Yes' at question '27 [1 CC]' (Are you involved in the management of patients with colorectal cancer?)

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

How many times have you used St. Mark's Lymph Node Positivity Model in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'46 [2 LNP]' (Do you
use the St.
Mark's Lymph Node Positivity Model?)

You've told us how many times you've used the St Mark's Lymph Node Positivity Model over the last
six months. This will be influenced by the number of patients with rectal cancer that you
manage. For what pe
rcentage of your patients with rectal cancer potentially treatable with local
resection, or for whom lymph node yield has been low, do you use the St Mark's Lymph Node
Positively Model?

Minimum 5% Maximum 95% *

Only answer this

question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '46 [2 LNP]' (Do
you use the St.
Mark's Lymph Node Positivity Model?)

What primary function does the St Mark's Lymph Node Positivity Model serve fo
r you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'46 [2 LNP]' (Do you use the St.
Mark's Lymph Node Positivity Model?)



Please choose only one of the following:



It helps me

make clinical decisions



It helps me explain management options / decisions to my patients



Other

Does using the St Mark's Lymph Node Positivity Model affect your clinical decisions?*

Only answer this question if the following conditions are met: Answer w
as 'Currently (within the last 6 months)' at question '46 [2 LNP]' (Do you use the St.
Mark's Lymph Node Positivity Model?)

Please choose only one of the following:



Yes
-

I offer FEWER patients local resection of a rectal malignancy



Yes
-

I offer MORE pat
ients local resection of a rectal malignancy



No
-

it doesn't affect my clinical decisions No
-

it doesn't affect my clinical decisions



Other

Do you think that using the St Mark's Lymph Node Positivity Model improves patients' outcomes in
your practice?
'Outcomes' may include, for example, reduction in side effects by avoiding
treatment (e.g. resection of the primary tumour and its draining lymph nodes), as well as overall
and disease free survival. *

Only answer this question if the following conditions
are met: Answer was 'Currently (within the last 6 months)' at question '46 [2 LNP]' (Do you use the St.
Mark's Lymph Node Positivity Model?)


Please choose only one of the following


Yes

No

Don’t know

Are there any factors which limit your use of the St Ma
rk's Lymph Node Positivity Model? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'46 [2 LNP]' (Do you use the St.
Mark's Lymph Node Positivity Model?)

Please choose all that ap
ply:



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other source



No
-

there are no factors wh
ich limit my use of the St Mark's Lymph Node Positivity Model



Other

&

Are there any factors which limit your use of the St Mark's Lymph Node Positivity Model? *

Only answer this question if the following conditions are met: Answer was 'Previously' at que
stion '46 [2 LNP]' (Do you use the St. Mark's Lymph Node
Positivity Model?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '27 [1 CC]' (Are you involved in
the management of patients with
colorectal cancer?) and

Answer was 'Never' at question '46 [2 LNP]' (Do you use the St. Mark's Lymph Node Positivity Model?)

Please choose all that apply:



I am not involved in making decisions about local resection or adjuvant treatment for
patients with rectal cancer, this tool

is not relevant to my current practice.



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other

source



No
-

there are no factors which limit my use of the St Mark's Lymph Node Positivity Model



Other

At the beginning of the questionnaire you told us that you have heard of other clinical decision
support systems used during the care of patients
with cancer. Please list the other clinical
decision support systems that you have heard of below.

Only answer this question if the following conditions are met: Answer was at question '6 [.]' (Which, if any, of the followin
g have you previously heard of?
)

Do you use {Other 1}? *

Only answer this question if the following conditions are met: Answer was NOT at question '55 [OtherList]' (At the beginning
of the questionnaire you told us
that you have heard of other clinical decision support systems used duri
ng the care of patients with cancer. Please list the other clinical decision support
systems that you have heard of below.)

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

How many times have you used {Other 1
} in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'56 [2 Other1]' (Do you use
{Other 1}?)


You've told us how many times you've used {Other 1} over the last

six months. This will be
influenced by the number of patients that you manage with the condition to which it applies. For
what percentage of these patients do you use this tool?

Minimum 5% Maximum 95% *

Only answer this questi
on if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '56 [2 Other1]' (Do you

use
{Other 1}?)

What primary function does using {Other 1} serve for you? *

Only answer this question if the following conditions
are met: Answer was 'Currently (within the last 6 months)' at question '56 [2 Other1]' (Do you use
{Other 1}?)



Please choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



O
ther

Does using {Other 1} affect your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'56 [2 Other1]' (Do you use
{INSERTANS:79132X63X4601}?)

Please choose
only one of the following:



Yes
-

I offer FEWER patients surgery / chemotherapy / radiotherapy



Yes
-

I offer MORE patients surgery / chemotherapy / radiotherapy



No
-

it doesn't affect my clinical



Other

Do you think that using {Other 1} improves patients'

outcomes in your practice? 'Outcomes' may
include, for example, reduction in side effects by avoiding treatment (e.g. chemotherapy), as
well as overall and disease free survival. *

Only answer this question if the following conditions are met: Answer was
'Currently (within the last 6 months)' at question '56 [2 Other1]' (Do you use
{Other 1}?)

Please choose only one of the following


Yes

No

Don’t know

Are there any factors which limit your use of {Other 1}? *

Only answer this question if the following con
ditions are met: Answer was 'Currently (within the last 6 months)' at question '56 [2 Other1]' (Do you use
{Other 1}?)

Please choose all that apply:



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence base



Conc
ern about the medico
-
legal implications of its use



Don't think it adds to information available from other source



No
-

there are no factors which limit my use of {Other 1}



Other


Are there any factors which limit your use of {Other 1}? *

Only answer thi
s question if the following conditions are met: Answer was 'Previously' at question '56 [2 Other1]' (Do you use {Other 1}?) a
nd Answer was
NOT at question '55 [OtherList]' (At the beginning of the questionnaire you told us that you have heard of other clin
ical decision support systems used
during the care of patients with cancer. Please list the other clinical decision support systems that you have heard of below
.)

Only answer this question if the following conditions are met: Answer was 'Never' at question

'56 [2 Other1]' (Do you use {Other 1}?) and Answer was NOT
at question '55 [OtherList]' (At the beginning of the questionnaire you told us that you have heard of other clinical decisio
n support systems used during the
care of patients with cancer. Please
list the other clinical decision support systems that you have heard of below.)


Please choose all that apply:



This tool is not relevant to my current practice.



Time pressure



Lack of adequate internet access in clinical settings



Concern about its evidence

base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other source



No
-

there are no factors which limit my use of {Other 1}



Other

(Questions 56
-
64 repeated for ‘Other 2’ and ‘Other 3')

83.

Do you
think there will be any change in the role of clinical decision support systems in the
management of patients with cancer over the next 10 years? (By clinicians in general rather than
by you specifically). *

Only answer this question if the following condi
tions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Please choose the appropriate response for each item:


Less

No Chan
ge

More

Frequency of use







Influence on decision making







Influence on decision making







Ability to IMPROVE patient outcome











84.

Please use the box below to add any additional comments you would like to make about the use
of clinical decision support systems in the management of patients with cancer.

Only answer this question if the following conditions are met: Answer was 'Yes' at

question '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Seciont 2: M
olecular tests

85.

Molecular tests examine samples at a genetic level. We are interested in t
hose molecular tests
that are used during the management of patients with cancer to provide prognostic information
or predict therapeutic response.

In this section we aim to discover how many clinicians currently use molecular tests during the
management o
f patients with cancer, what they are used for, and whether there factors which limit
their uptake.

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid

organ or haematological malignancy who is currently practicing in New Zealand?)

86.

Which, if any, of the following have you previously heard of? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a
clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Please choose all that apply:



Mammaprint

-

for breast cancer prognostication



Oncotype Dx
-

for breast cancer prognostication




FLT
3 mutation analysis
-

for patients with cytogenetically normal Acute Myeloid
Leukaemia



CEBPA mutation analysis
-

for patients with cytogenetically normal Acute Myeloid
Leukaemia



NPM1 mutation analysis
-

for patients with cytogenetically normal Acute Myeloid
Leukaemia



KRAS genotyping
-

to predict response to panitumumab/cetuximab



UGT1A1 mutation analysis
-

to predict irinotecan toxicity



EGFR mutation analysis
-

prior to treatmen
t with EGFR
-
tyrosine kinase inhibitors



I have not heard of any of these molecular tests I have not heard of any of these
molecular tests

87.

Do you use Mammaprint®? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question
'7 [1 BC ]' (Are you involved in the management of patients with
breast cancer?) and Answer was at question '86 [.]' (Which, if any, of the following have you previously heard of? )

Please choose only one of the following:



Currently (within the last 6 mont
hs)



Previously



Never

88.

Was your previous experience with Mammaprint® in New Zealand or overseas? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '87 [2 mamm]' (Do you use
Mammaprint®?)

89.

How many times have

you requested a Mammaprint® test in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'87 [2 mamm]' (Do you use
Mammaprint®?)

90.

You've told us how many times you
've used Mammaprint® over the last six months. This will be
influenced by the number of women that you treat early stage breast cancer. For what
percentage of these patients do you request this test ?

Minimum 5% Maximum 95% *

O
nly answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '
87 [2 mamm]' (Do you use
Mammaprint®?)

91.

What primary function does using the Mammaprint® test serve for you? *

Only answer this ques
tion if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '87 [2 mamm]' (Do you

use
Mammaprint®?)



Please choose only one of the following:



It helps me make clinical decisions



It helps me explain management opti
ons / decisions to my patients



Other

92.

Does using Mammaprint® affect your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'87 [2 mamm]' (Do you use
Mammaprin
t®?)

Please choose only one of the following:



Yes
-

I refer FEWER patients to medical oncology or offer chemotherapy to FEWER
patients



Yes
-

I refer MORE patients to medical oncology or offer chemotherapy to MORE patients



No
-

it doesn't affect my clinical decisions



Other


93.

Do you think that using Mammaprint® improves patient outcome in your practice? 'Outcomes'
may include, for example, reduction in side effects by avoiding treatment (e.g. chemotherapy)
as well as overall a
nd disease free survival. *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'87 [2 mamm]' (Do you use
Mammaprint®?)

Please choose only one of the following


Yes

No

Don’t know

94.

Are

there any factors which limit your use of Mammaprint®? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'87 [2 mamm]' (Do you use
Mammaprint®?)

Please choose all that apply:



Tim
e pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of

Mammaprint



Other

95.

&

96.

Are there any factors which limit your use of Mammaprint®? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '87 [2 mamm]' (Do you use
Mammaprint®?)

Only answer this question if the fol
lowing conditions are met: Answer was 'Never' at question '87 [2 mamm]' (Do you use Mammaprint®?)

Please choose all that apply:



I am not involved in making decisions about adjuvant therapy, this tool is not relevant to
my current practice.



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of Mammaprint



Other

97.

Do you use Oncotype Dx®? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '7 [1 BC ]' (Are you involved in
the management of patients with
breast cancer?) and Answer was at question '86 [.]' (Which, if any
, of the following have you previously heard of? )

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

98.

Was your previous experience with Oncotype Dx® for breast cancer in New Zealand or
overseas? *

Only answer th
is question if the following conditions are met: Answer was 'Previously' at question '97 [2 onc]' (Do you use Oncotype Dx®?)

99.

How many times have you requested an Oncotype Dx® test in the last 6 months? *


Only answer this question if the following condition
s are met: Answer was 'Currently (within the last 6 months)' at question '97 [2 onc]' (Do you use
Oncotype Dx®?)

100.

You've told us how many times you've used Oncotype Dx® over the last six months. This will
be influenced by the number of women that you treat
with early stage, ER+ breast cancer. For
what percentage of these patients do you request this

test ? *

Minimum 5% Maximum 95%

Only answer this question if the following conditions are met: Answer was 'Currently (within the la
st 6 months)' at question '97 [2 onc]' (Do you use
Oncotype Dx®?)

101.

What primary function does using the Oncotype Dx® test serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at qu
estion '97 [2 onc]' (Do you use
Oncotype Dx®?)

Please choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

102.

Does using Oncotype Dx® affect your clinical decisions? *

Only answer this question if the following conditions are met:° Answer was 'Currently (within the last 6 months)' at question

'97 [2 onc]' (Do you use
Oncotype Dx®?)

Please choose only one of the following:



Yes
-

I refer FEWER patients to medical oncology or offer chemotherapy to FEWER
patients



Yes
-

I refer MORE patients to medical oncology or offer chemotherapy to MORE patients



No
-

it doesn't affect my clinical decisions



Other

103.

Do you think that using On
cotype Dx® improves patient outcome in your practice?
'Outcomes' may include, for example, reduction in side effects by avoiding treatment (e.g.
chemotherapy) as well as overall and disease free survival. *

Only answer this question if the following condit
ions are met: Answer was 'Currently (within the last 6 months)' at question '97 [2 onc]' (Do you use
Oncotype Dx®?)

Please choose only one of the following


Yes

No

Don’t know

104.

Are there any factors which limit your use of Oncotype Dx®? *

Only answer this q
uestion if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '97 [2 onc]' (Do y
ou use
Oncotype Dx®?)

Please choose all that apply:



Time pressure



Concern about its evidence base



Concern about the medico
-
legal
implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of Onco
type
Dx



Other

105.

&

106.

Are there any factors which limit your use of Oncotype
Dx®? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '97 [2 onc]' (Do you use O
ncotype Dx®?)


Only answer this question if the following conditions are met: Answer was 'Never' at question '97 [2 onc]' (Do

you use Oncotype Dx®?)

Please choose all that apply:



I am not involved in making decisions about adjuvant therapy, this tool is not relevant to
my current practice.



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of Onco
type
Dx



Other

107.

Are you involved in the ma
nagement of patients with acute myeloid leukaemia? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological malignancy who is curr
ently practicing in New Zealand?)

Please choose only one of the following


Yes

No

108.

Do you use FLT3 mutation analysis? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the manag
ement of patients
with acute myeloid leukaemia?) and Answer was at question '86 [.]' (Which, if any, of the following have you previously heard

of? )

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

109.

Was your pr
evious experience with FLT3 testing in New Zealand or overseas? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '108 [2 AML FLT3]' (Do you

use FLT3 mutation analysis?)

110.

How many times have you requested F
LT3 mutation analysis for patients with CN
-
AML in the
last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'108 [2 AML FLT3]' (Do you use
FLT3 mutation analysis?)

111.

You'
ve told us how many times you've used FLT3 mutation analysis over the last six months.
This will be influenced by the number of patients with cytogenetically normal AML that you
manage. For what percentage of your patients with cytogenetically normal AML d
o you use this
tool?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'108 [2 AML FLT3]' (Do you use
FLT3 mutation analysis?)

112.

What primary function does using FLT3 mutation analysis serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'108 [2 AML FLT3]' (Do you use
FLT3 mutation analysis?)

Pl
ease choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

113.

Does using FLT3 mutation analysis affect your clinical decisions? *


Only answer this question if the
following conditions are met: Answer was 'Currently (within the last 6 months)' at question '108 [2 AML FLT3]' (Do you use
FLT3 mutation analysis?)

Please choose only one of the following:



Yes
-

I more commonly offer (further) chemotherapy



Yes
-

I more co
mmonly offer allogeneic stem cell transplant



Yes
-

I more commonly offer deferment of further treatment



No
-

it doesn't affect my clinical decisions



Other

114.

Do you think that FLT3 mutation analysis improves patient outcome in your practice?
'Outcomes' may

include, for example, reduction in side effects by avoiding treatment (e.g.
allogeneic stem cell transplantation) as well as overall and disease free survival. *

Only answer this question if the following conditions are met: Answer was 'Currently (within
the last 6 months)' at question '108 [2 AML FLT3]' (Do you use
FLT3 mutation analysis?)

Please choose only one of the following


Yes

No

Don’t know

115.

Are there any factors which limit your use of FLT3 mutation analysis for patients with
cytogenetically norma
l AML? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid leukaemia?) and Answer was 'Currently (within the last 6 months)' at quest
ion '108 [2 AML FLT3]' (Do you use FLT3 mutation analysis?)

Please choose all that apply:



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other source
s



Cost of the test to my patient / the health system



No
-

there are no factors which limit my use of FLT3 mutation analysis



Other

116.

&

117.

Are there any factors which limit your use of FLT3 mutation analysis for patients with
cytogenetically normal AML? *

Only
answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved in the

management of patients
with acute myeloid leukaemia?) and Answer was 'Previously' at question '108 [2 AML FLT3]' (Do you use FLT3
mutation analysis?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid leukaemia?) and Answer was 'Never' at question '108 [2 AML FLT3
]' (Do you use FLT3 mutation analysis?)

Please choose all that apply:



This test is not relevant to my current practice



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to
information available from other sources



Cost of the test to my patient / the health system



No
-

there are no factors which limit my use of FLT3 mutation analysis



Other

118.

Do you use CEBPA mutation analysis? *


Only answer this question if the following cond
itions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved in the management of patients
with acute myeloid leukaemia?) and Answer was at question '86 [.]' (Which, if any, of the following have you previously heard

of? )

Please choose onl
y one of the following:



Currently (within the last 6 months)



Previously



Never

119.

Was your previous experience with CEBPA tests in New Zealand or overseas? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '11
8 [2 AML CEBPA]' (Do you use CEBPA mutation
analysis?)

120.

How many times have you requested CEBPA mutation analysis for patients with CN
-
AML in
the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within t
he last 6 months)' at question '118 [2 AML CEBPA]' (Do you use
CEBPA mutation analysis?)

121.

You've told us how many times you've used CEBPA mutation analysis over the last six
months. This will be influenced by the number of patients with cytogenetically norm
al AML that
you manage. For what percentage of patients with cytogenetically normal AML do you use this
tool?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within

the last 6 months)' at question '118 [2 AML CEBPA]' (Do you use
CEBPA mutation analysis?)

122.

What primary function does using CEBPA mutation analysis serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (withi
n the last 6 months)' at question '118 [2 AML CEBPA]' (Do you use
CEBPA mutation analysis?)

Please choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

123.

Does using
CEBPA mutation analysis affect your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'118 [2 AML CEBPA]' (Do you use
CEBPA mutation analysis?)

Please choose o
nly one of the following:



Yes
-

I more commonly offer (further) chemotherapy



Yes
-

I more commonly offer allogeneic stem cell transplant



Yes
-

I more commonly offer deferment of further treatment



No
-

it doesn't affect my clinical decisions



Other

124.

Do yo
u think that CEBPA mutation analysis improves patient outcome in your practice?
'Outcomes' may include, for example, reduction in side effects by avoiding treatment (e.g.
allogeneic stem cell transplantation) as well as overall and disease free survival. *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'118 [2 AML CEBPA]' (Do you use
CEBPA mutation analysis?)

Please choose only one of the following


Yes

No

Don’t know

125.

Are there an
y factors which limit your current use of CEBPA mutation analysis for patients
with cytogenetically normal AML? *


Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management
of patients
with acute myeloid leukaemia?) and Answer was 'Currently (within the last 6 months)' at question '118 [2 AML CEBPA]' (Do you
use CEBPA mutation
analysis?)

Please choose all that apply:



Time pressure



Concern about its evidence base



Concern abo
ut the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no factors which limit my use of CEBPA mutation analysis



Other:

126.

&

127.

Are there a
ny factors which limit your current use of CEBPA mutation analysis for patients
with cytogenetically normal AML? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management

of patients
with acute myeloid leukaemia?) and Answer was 'Previously' at question '118 [2 AML CEBPA]' (Do you use CEBPA mutation analysi
s?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid leukaemia?) and Answer was 'Never' at question '118 [2 AML CEBPA]' (Do you use CEBP
A mutation analysis?)

Please choose all that apply:



This test is not relevant to my current practice



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from
other sources



Cost of the test to my patient / the health system



No
-

there are no factors which limit my use of CEBPA mutation analysis



Other:

128.

Do you use NPM1 mutation analysis? *

Only answer this question if the following conditions are met: Answer wa
s 'Yes' at question '107 [1 AML]' (Are you involved in the management of patients
with acute myeloid leukaemia?) and Answer was at question '86 [.]' (Which, if any, of the following have you previously heard

of? )

Please choose only one of the following:



C
urrently (within the last 6 months)



Previously



Never

129.

Was your previous experience with NPM1 testing in New Zealand or overseas? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '128 [2 AML NPM1]' (Do you

use NPM1 mutation
analysis?)

130.

How many times have you requested NPM1 mutation analysis for patients with CN
-
AML in the
last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at quest
ion '128 [2 AML NPM1]' (Do you use
NPM1 mutation analysis?)

131.

You've told us how many times you've used NPM1 mutation analysis over the last six
months. This will be influenced by the number of patients with cytogenentically normal AML that
you manage. For w
hat percentage of your patients with cytogenetically normal AML do you use
this tool?


Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at

question '128 [2 AML NPM1]' (Do you use
NPM1 mutation analysis?)

132.

What primary function does using NPM1 mutation analysis serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at q
uestion '128 [2 AML NPM1]' (Do you use
NPM1 mutation analysis?)

Please choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

133.

Does using NPM1 mutation analysis affect
your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'128 [2 AML NPM1]' (Do you use
NPM1 mutation analysis?)

Please choose only one of the following:



Yes
-

I

more commonly offer (further) chemotherapy



Yes
-

I more commonly offer allogeneic stem cell transplant



Yes
-

I more commonly offer deferment of further treatment



No
-

it doesn't affect my clinical decisions



Other

134.

Do you think that NPM1 mutation analys
is improves patient outcome in your practice?
'Outcomes' may include, for example, reduction in side effects by avoiding treatment (e.g.
allogeneic stem cell transplantation) as well as overall and disease free survival. *

Only answer this question if the
following conditions are met: Answer was 'Currently (within the last 6 months)' at question '128 [2 AML NPM1]' (Do you use
NPM1 mutation analysis?)

Please choose only one of the following


Yes

No

Don’t know

135.

Are there any factors which limit your use of NP
M1 mutation analysis for patients with
cytogenetically normal AML? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid leukaemia?) an
d Answer was 'Currently (within the last 6 months)' at question '128 [2 AML NPM1]' (Do you use NPM1 mutation
analysis?)

Please choose all that apply:



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Do
n't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no factors which limit my use of NPM1 mutation analysis



Other

136.

&

137.

Are there any factors which limit your use of NPM1 mutation a
nalysis for patients with
cytogenetically normal AML? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid leukaemia?) and Answer was
'Previously' at question '108 [2 AML FLT3]' (Do you use FLT3 mutation analysis?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid le
ukaemia?) and Answer was 'Never' at question '128 [2 AML NPM1]' (Do you use NPM1 mutation analysis?)


Please choose all that apply:



This test is not relevant to my current practice



Time pressure



Concern about its evidence base



Concern about the medico
-
le
gal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no factors which limit my use of NPM1 mutation analysis



Other

138.

Do you prescribe chemotherapy? I
n particular do you ever prescribe irinotecan, cetuximab,
or EGFR
-
tyrosine kinase inhibitors? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
org
an or haematological malignancy who is currently practicing in New Zealand?)

Please choose only one of the following


Yes

No

139.

Do you use KRAS genotyping? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1
Chemo]' (Do you prescribe chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was at question '86 [.]' (Which, if any, of the following have
you previously heard of? )

Please choose only
one of the following:



Currently (within the last 6 months)



Previously



Never

140.

Was your previous experience with KRAS genotyping in New Zealand or overseas? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '
139 [2 chemo KRAS]' (Do you use KRAS genotyping?)

141.

How many times have you requested KRAS genotyping in the last 6 months? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'139 [2

chemo KRAS]' (Do you
use KRAS genotyping?)

142.

You've told us how many times you've used KRAS genotyping over the last six months. This
will be influenced by the number of patients you consider for treatment with cetuximab or
panitumumab.

For what percentage
of these patients do you request KRAS genotyping?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'139 [2 chemo KRAS
]' (Do you
use KRAS genotyping?)

143.

What primary function does using KRAS genotyping serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'139 [2 chemo KRAS]' (Do you
use

KRAS genotyping?)

Please choose only one of the following:



It helps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

144.

Does using KRAS genotyping affect your clinical decisions? *

Only answer this question
if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '139 [2 chemo KRAS]' (Do y
ou
use KRAS genotyping?)


Please choose only one of the following:



Yes
-

I offer FEWER patients treatment with panitumumab / cetuxim
ab



Yes
-

I offer MORE patients treatment with panitumumab / cetuximab



No
-

it doesn't affect my clinical decisions



Other

145.

Do you think that KRAS genotyping improves patient outcome in your practice? 'Outcomes'
may include, for example, reduction in s
ide effects, as well as overall and disease free survival. *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'139 [2 chemo KRAS]' (Do you
use KRAS genotyping?)

Please choose only
one of the following


Yes

No

Don’t know

146.

Are there any factors which limit your use of KRAS genotyping for patients who may benefit
from treatment with cetuximab or panitumumab? *

Only answer this question if the following conditions are met: Answer was 'Y
es' at question '138 [1 Chemo]' (Do you prescribe chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Currently (within the last 6 months)' at question '139 [2
chemo KRAS]' (Do you u
se KRAS genotyping?)

Please choose all that apply:



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the hea
lth system



No
-

there are no barriers to my use of KRAS mutation analysis



Other:

147.

&

148.

Are there any factors which limit your use of KRAS genotyping for patients who may benefit
from treatment with cetuximab or panitumumab? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe

chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Prev
iously' at question '139 [2 chemo KRAS]' (Do you use
KRAS genotyping?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe

chemotherapy? In particular
do you ever prescribe irinoteca
n, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Never' at question '139 [2 chemo KRAS]' (Do you use
KRAS genotyping?)

Please choose all that apply:



This test is not relevant to my current practice



Time pressure



Concern about its evidenc
e base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of KRAS mutation analysis



Other:

149.

Do you us
e UGT1A1 mutation analysis? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe

chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inh
ibitors?) and Answer was at question '86 [.]' (Which, if any, of the following have
you previously heard of? )


Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

150.

Was your previous experience with UGT1A1 genotypin
g in New Zealand or overseas? *

Only answer this question if the following conditions are met: Answer was 'Previously' at question '149 [2 chemo UGT1A1]' (Do

you use UGT1A1 mutation
analysis?)

151.

How many times have you requested UGT1A1 mutation analysis in t
he last 6 months? *

Only answer this question if the following conditions are met:° Answer was 'Currently (within the last 6 months)' at question

'149 [2 chemo UGT1A1]' (Do
you use UGT1A1 mutation analysis?)

152.

You've told us how many times you've used UGT1A1

mutation analysis over the last six
months. This will be influenced by the number of patients you consider for treatment with
irinotecan. For what percentage of these patients do you request UGT1A1 mutation analysis?

Minimum 5%

Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'149 [2 chemo UGT1A1]' (Do you
use UGT1A1 mutation analysis?)

153.

What primary function does using UGT1A1 mutation anal
ysis serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'149 [2 chemo UGT1A1]' (Do you
use UGT1A1 mutation analysis?)

Please choose only one of the following:



It hel
ps me make clinical decisions



It helps me explain management options / decisions to my patients



Other

154.

Does using UGT1A1 mutation analysis affect your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Currently

(within the last 6 months)' at question '149 [2 chemo UGT1A1]' (Do you
use UGT1A1 mutation analysis?)

Please choose only one of the following:



Yes
-

I offer FEWER patients treatment with irinotecan



Yes
-

I offer MORE patients treatment with irinotecan



No
-

it doesn't affect my clinical decisions



Other

155.

Do you think that UGT1A1 mutation analysis improves patient outcome in your practice?
'Outcomes' may include, for example, reduction in side effects, as well as overall and disease
free survival. *

Only answe
r this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question '149 [2 ch
emo UGT1A1]' (Do you
use UGT1A1 mutation analysis?)

Please choose only one of the following


Yes

No

Don’t know

156.

Are there any facto
rs which limit your use of UGT1A1 mutation analysis for patients who may
benefit from treatment with irinotecan? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe

chemotherapy? I
n particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Currently (within the last 6 months)' at question '149 [2
chemo UGT1A1]' (Do you use UGT1A1 mutation analysis?)

Please choose all that apply:



Tim
e pressure



Concern about its evidence base




Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of
UGT1A1 mutation analysis



Other:

157.

&

158.

Are there any factors which limit your use of UGT1A1 mutation analysis for patients who may
benefit from treatment with irinotecan? *

Only answer this question if the following conditions are met: Answer was 'Yes' at ques
tion '138 [1 Chemo]' (Do you prescribe chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Previously' at question '149 [2 chemo UGT1A1]' (Do you
use UGT1A1 mutation analysis?)

Only
answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe chem
otherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Never' at

question '149 [2 chemo UGT1A1]' (Do you use
UGT1A1 mutation analysis?)

Please choose all that apply:



This test is not relevant to my current practice



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don'
t think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of UGT1A1 mutation analysis



Other:

159.

Do you use EGFR mutation analysis? *

Only answer this question if the fo
llowing conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was at question '86 [.]' (Which, if any, of
the following have
you previously heard of? )

Please choose only one of the following:



Currently (within the last 6 months)



Previously



Never

160.

Was your previous experience with EGFR mutation analysis in New Zealand or overseas? *

Only answer this question if

the following conditions are met: Answer was 'Previously' at question '159 [2 Chemo EGFR]' (Do you use EGFR mutation
analysis?)

161.

How many times have you requested EGFR mutation analysis in the last 6 months? *

Only answer this question if the following con
ditions are met: Answer was 'Currently (within the last 6 months)' at question '159 [2 Chemo EGFR]' (Do you
use EGFR mutation analysis?)

162.

You've told us how many times you've used EGFR mutation analysis over the last six months.
This will be influenced by t
he number of patients you consider for treatment with EGRF
-
tyrosine
kinase inhibitors. For what percentage of these patients do you request EGFR mutation analysis?

Minimum 5% Maximum 95% *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'159 [2 Chemo EGFR]' (Do you
use EGFR mutation analysis?)

163.

What primary function does using EGFR mutation analysis serve for you? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'159 [2 Chemo EGFR]' (Do you
use EGFR mutation analysis?)


Please choose only one of the following:



It helps me make clinical decisi
ons



It helps me explain management options / decisions to my patients



Other

164.

Does using EGFR mutation analysis affect your clinical decisions? *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)'

at question '159 [2 Chemo EGFR]' (Do you
use EGFR mutation analysis?)

Please choose only one of the following:



Yes
-

I offer FEWER patients treatment with EGFR
-
tyrosine kinase inhibitors



Yes
-

I offer MORE patients treatment with EGFR
-
tyrosine kinase inh
ibitors



No
-

it doesn't affect my clinical decisions



Other

165.

Do you think that EGFR mutation analysis improves patient outcome in your practice?
'Outcomes' may include, for example, reduction in side effects, as well as overall and disease
free survi
val. *

Only answer this question if the following conditions are met: Answer was 'Currently (within the last 6 months)' at question
'159 [2 Chemo EGFR]' (Do you
use EGFR mutation analysis?)

Please choose only one of the following


Yes

No

Don’t know

166.

Are th
ere any factors which limit your use of EGFR mutation analysis for patients who may
benefit from treatment with EGFR
-
tyrosine kinase inhibitors? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (
Do you prescribe chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Currently (within the last 6 months)' at question '159 [2
Chemo EGFR]' (Do you use EGFR mutation analysis?)

Pleas
e choose all that apply:



Time pressure



Concern about its evidence base



Concern about the medico
-
legal implications of its use



Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of EGFR mutation analysis



Other:

167.

&

168.

Are there any factors which limit your use of EGFR mutation analysis for patients who may
benefit from treatment with EGFR
-
tyrosine kinase inhibitors? *

Only answer this question if th
e following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
tyrosine kinase inhibitors?) and Answer was 'Previously' at question '159 [2 Che
mo EGFR]' (Do you use
EGFR mutation analysis?)

Only answer this question if the following conditions are met: Answer was 'Yes' at question '138 [1 Chemo]' (Do you prescribe

chemotherapy? In particular
do you ever prescribe irinotecan, cetuximab, or EGFR
-
ty
rosine kinase inhibitors?) and Answer was 'Never' at question '159 [2 Chemo EGFR]' (Do you use
EGFR mutation analysis?)

Please choose all that apply:



This test is not relevant to my current practice



Time pressure



Concern about its evidence base



Concern ab
out the medico
-
legal implications of its use




Don't think it adds to information available from other sources



Cost of the test to my patient / the health system



No
-

there are no barriers to my use of EGFR mutation analysis



Other:

169.

Do you think there will be

any change in the use of molecular tests in the management of
patients with cancer over the next 10 years? (By clinicians in general rather than by you
specifically). *

Only answer this question if the following conditions are met: Answer was 'Yes' at que
stion '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Please choose the appropriate response for each item:


Less

No Change

More

Frequency of use







Influence on decision making







Influence on decision making







Ability to IMPROVE patient outcome












170.

Please add any additional comments you would like to make about the use of molecular tests
in the management of patients with cancer
below.

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Section 3:
S
cenarios

171.

We would now like you to briefly consider the health economics' implications of clinical
decision support systems and molecular tests. The scenarios we present are hypothetical but
concern issues which clinicians, health care policy makers and gro
ups aiming to commercialise
their translational research, must consider.

We will only present you with scenarios which relate to your speciality.

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a

clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Breast Cancer

172.

You have a peri
-
menopausal 50 year old

patient with a screening detected right breast
cancer. Her paternal aunt had breast cancer but she has no other family history. Your patient
was treated with wide local excision and sentinel lymph node biopsy. Histolopathology has
confirmed a unifocal gra
de 2, 25mm, ER/PR +ve, HER2
-
ve, infiltrating ductal carcinoma without
lymph node involvement (0/3) (T2N0M0), with clear margins. She will be treated with local
radiation therapy and appropriate endocrine therapy. A genomic test is available which
accurate
ly and reliably predicts her risk of disease recurrence, and of chemotherapeutic
response.

Only answer this question if the following conditions are met: Answer was 'Yes' at question '7 [1 BC ]' (Are you involved in
the management of patients with
breast c
ancer?)

173.

How much do you think this test is worth in the current New Zealand market?

Only answer this question if the following conditions are met: Answer was 'Yes' at question '7 [1 BC ]' (Are you involved in
the management of patients with
breast cancer?)


174.

Do you think a test of this nature has the potential to save the public health service /
patients / insurers money by reducing the amount of chemotherapy prescribed to those
predicted to have a good outcome?

Only answer this question if the following cond
itions are met: Answer was 'Yes' at question '7 [1 BC ]' (Are you involved in the management of patients with
breast cancer?)

Please choose only one of the following


Yes

No

Don’t know

Colorectal cancer

175.

You have a middle
-
aged patient who is otherwise fit
and well and has no significant family
history. They have recently been diagnosed with colon cancer. They underwent appropriate
preoperative staging followed by definitive resection with primary anastomosis, and have
recovered well. Their disease (by a com
bination of pathological, radiological and clinical
examination) has been staged as T3N0M0. A genomic test is available which will accurately and
reliably predict their risk of disease recurrence, and the probability that it will respond to specific
chemot
herapeutic agents.

Only answer this question if the following conditions are met: Answer was 'Yes' at question '27 [1 CC]' (Are you involved in
the management of patients with
colorectal cancer?)

176.

How much do you think this test is worth in the current New
Zealand market?

Only answer this question if the following conditions are met: Answer was 'Yes' at question '27 [1 CC]' (Are you involved in
the management of patients with
colorectal cancer?)

177.

Do you think a test of this nature has the potential to save th
e public health service /
patients / insurers money by reducing the amount of chemotherapy prescribed to those
predicted to have a good outcome?

Only answer this question if the following conditions are met: Answer was 'Yes' at question '27 [1 CC]' (Are yo
u involved in the management of patients with
colorectal cancer?)

Please choose only one of the following


Yes

No

Don’t know

Acute M
yeloid Leukaemia

178.

You have a 40 year old patient with acute myeloid leukaemia, picked up on a blood tests to
investigate thr
ee months of ‘flu
-
like’ symptoms. He has no co
-
morbidities and has not previously
been exposed to cyto
-
toxic agents. Your patient was treated with routine induction
chemotherapy and has achieved complete remission. Treatment options are now either
consolid
ation chemotherapy or allogeneic stem cell transplant. A genomic test is available which
can accurately and reliably predict his risk of disease relapse, and can predict response to certain
chemotherapeutic agents

Only answer this question if the following

conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved in the management of patients
with acute myeloid leukaemia?)

179.

How much do you think this test is worth in the current New Zealand market?

Only answer this question if the foll
owing conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved in the management of patients
with acute myeloid leukaemia?)

180.

Do you think a test of this nature has the potential to save the public health service /
patients / insurers

money by reducing the amount of chemotherapy prescribed to those
predicted to have a good outcome? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '107 [1 AML]' (Are you involved i
n the management of patients
with acute myeloid leukaemia?)

Please choose only one of the following


Yes

No

Don’t know

181.

Please use the text box below if you wish to make any additional comments.

Only answer this question if the following conditions are met: Answer was 'Yes' at
question '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

About You

182.

What is your specialty? *


Only answer this question if the following conditions are met: Ans
wer was 'Yes' at question '2 [.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Please choose only one of the following:



Medical Oncologist



Radiation Oncologist



Path
ologist



Haematologist



General Surgeon

183.

What is your level of seniority? *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2 [.]' (Are you a clinician invo
lved in the management of solid
organ or haematological ma
lignancy who is currently practicing in New Zealand?)

Please choose only one of the following:



Specialist



Registrar/Fellow



Other

184.

For how many years have you been working as a specialist? *

Only answer this question if the following conditions are met: Answ
er was 'Specialist' at question '183 [2 PI]' (What is your level of seniority?) and Answer
was 'Yes' at question '2 [.]' (Are you a clinician involved in the management of solid organ or haematological malignancy who

is currently practicing in New
Zealand?
)

185.

At which of the following locations are you employed?

Tertiary hospitals: Auckland, National Women's, Middlemore, Waikato, Wellington, Christchurch,
Dunedin *

Only answer this question if the following conditions are met: Answer was 'Yes' at question '2
[.]' (Are you a clinician involved in the management of solid
organ or haematological malignancy who is currently practicing in New Zealand?)

Please choose all that apply:



Tertiary public hospital



Secondary public hospital



Private practice



University

186.

Other

Thank you for completing this survey.