Idiopathic Inflammatory Myopathies and Malignancy Screening: A Survey of Current Practices Amongst Canadian Neurologists and Rheumatologists.

Abstract

Introduction/aims: Although the need for malignancy screening in idiopathic inflammatory myopathies (IIM) is generally accepted, data to guide the choice and timing of investigations are limited. Our aim was to characterize the gaps and uncertainties amongst Canadian neurologists and rheumatologists with respect to malignancy screening in IIM.

Methods: An online survey consisting of 18 multiple-choice questions related to malignancy screening practices was distributed to adult neurologists and rheumatologists practising in Canada, and survey responses were described and compared between groups.

Results: Of 69 participants, the majority (95.7%) performed malignancy screening. However, there was variability in practice including delegation and choice of screening tests, influence of patient-specific factors, and timing of repeat testing relative to original testing. Only 18.2% of respondents were confident in their malignancy screening practices. The most significant perceived knowledge gap was lack of consensus or guidelines on choice and frequency of malignancy screening (92.8%). Compared with neurologists, rheumatologists saw a higher number of IIM patients per year (72.5% vs. 41.4% reported five or more, p = 0.009), were more likely to consider patient risk factors and order more investigations, while neurologists were more likely to repeat testing.

Discussion: Variability and knowledge gaps exist amongst neurologists and rheumatologists with regard to malignancy screening in IIM patients. The identified variability and lack of confidence may lead to lack of standardization of care, and potentially either under- or over-investigating of IIM patients for malignancy. Further research is required to better understand the optimal choice of tests and timing of repeat investigations.