Real-world challenges in the adoption of emerging therapies for extensive-stage small cell lung cancer in community settings.

Abstract

8113 Background: Despite advances in the treatment of extensive-stage small cell lung cancer (ES-SCLC), outcomes remain poor, and uptake of novel therapies in community oncology settings is inconsistent. As the ES-SCLC treatment landscape rapidly evolves, understanding real-world knowledge gaps, operational barriers, and challenges in patient-centered care is critical to improving evidence-based practice. This study evaluated community oncologists’ confidence, practice patterns, and perceived barriers to integrating novel and emerging ES-SCLC therapies. Methods: From September–October 2025, 100 US community oncologists completed surveys assessing treatment selection, shared decision-making, adverse event (AE) management, clinical trial referral practices, and system-level barriers to care delivery for patients with SCLC. Results: Knowledge and training gaps were the most frequently cited challenges to incorporating novel therapies (55%), followed by electronic medical record workflow limitations (41%) and patient selection complexity (33%). While most oncologists reported a basic understanding of novel antibody-drug conjugates (72%), few actively followed emerging clinical data (19%). Delays in initiating first-line therapy were commonly attributed to unfamiliarity with available treatments or need for academic referral (56%), prolonged staging evaluations (53%), and limited infusion center capacity (39%). AE management represented a major unmet need: 90% reported difficulty educating patients and caregivers on early AE recognition, and 62% reported challenges distinguishing disease progression from treatment-related toxicity. These gaps directly affected patient-centered care, with barriers to shared decision-making including limited clinician knowledge of treatment options (80%) and difficulty tailoring communication to patient preferences (66%). Accordingly, improved AE management was identified as the single greatest opportunity to enhance quality of care (51%). Although most oncologists reported referring patients for clinical trial evaluation after progression most or all of the time (85%; 4-5 on 5-point Likert scale), enrollment was hindered by patient preferences (63%), limited infrastructure to identify and enroll eligible patients (51%), and poor performance status (40%). Conclusions: Community oncologists face significant knowledge and operational barriers to integrating novel therapies for ES-SCLC, particularly related to emerging mechanisms of action, AE recognition and management, patient communication, and clinical trial enrollment. Targeted educational and practice-based interventions are needed to support timely, patient-centered, and evidence-based care in the community setting.