ESTRO 2025 - Abstract Book

S2352

Interdisciplinary – Other

ESTRO 2025

References 1. Hanna T P & King W D, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis BMJ 2020; 371 2. Raphael MJ, & Saskin R, et al. Association between waiting time for radiotherapy after surgery for early-stage breast cancer and survival outcomes in Ontario: a population-based outcomes study. Curr Oncol. 2020 Apr;27(2):e216-e221. 3. Forner D & Murnaghan S, et al. Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic. Curr Oncol. 2021 May 13;28(3):1867-1878. 4. Song H & Fang F, et al. Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study. BMC Cancer. 2017 Jan 3;17(1):2.

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Digital Poster A systematic review of pragmatic randomized controlled trials in oncology Kiran Phaterpekar 1 , Aruni Jayatilaka 2 , Gabriel Boldt 3 , David Palma 3 , Glenn Bauman 3 , Sympascho Young 3 1 Faculty of Medicine, UBC, Vancouver, Canada. 2 School of Medicine, Queen's University, Kingston, Canada. 3 Schulich School of Medicine & Dentistry, Western University, London, Canada Purpose/Objective Pragmatic randomized controlled trials (RCTs) have become increasingly common in oncology. Compared to explanatory RCTs, pragmatic RCTs are more susceptible to bias but may offer better external validity. This study assessed the pragmatism of pragmatic RCTs in oncology using a validated tool. Material/Methods This systematic review, registered with PROSPERO (CRD42023425295), searched PubMed, EMBASE, and Cochrane databases for RCTs with ‘pragmatic’, or related terms, in the title, abstract, or index terms. All RCTs with oncological disease-modifying interventions were included. Pragmatism was assessed using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2). Study authors were contacted and invited to score their trials. RCTs were grouped thematically into 6 archetypes: practical/novel trial design, real-world setting: eligibility, real-world setting: treatment flexibility, de-escalated/practical intervention, patient-reported endpoint, and no pragmatic element. Results Our search yielded 1322 studies; 32 were eligible. Trials were in medical oncology (14), radiation oncology (8), hematology-oncology (3), surgical oncology (13) and cross-specialty (5). Median publication year was 2017 (range: 1993-2022), with 28 studies published in the last decade. Most studies were multicentre (n=27), with a median of 11 centres (range: 1-542); 13 were multinational. Trials spanned 6 continents. Intention-to-treat analysis was used in 81.2% (26/32) of studies. No trials reported PRECIS-2 scores in their original manuscripts. 8 of the contacted authors scored their own studies and there were no significant differences between author and researcher-scored PRECIS-2. The overall mean PRECIS-2 was 3.9/5 (range: 2.4-4.9). There were no significant differences in PRECIS-2 between different medical specialties. 11 studies met criteria for being "overall pragmatic"; of these, 8 were self-labeled as pragmatic by their authors. Self-labeled trials did not have significantly different PRECIS scores (p=0.74). Trials grouped into the 'no pragmatic element' archetype corresponded with lower PRECIS-2 scores than those not grouped into this archetype (p=0.045). Studies within the 'real-world setting eligibility' archetype scored higher than their counterpart (p=0.028). Mean journal impact factor was 22.8 (range 1.1-98.4). Journal impact factor was positively correlated with PRECIS-2 (p=0.016), although NIH relative citation ratio for each article was not. Conclusion The number of pragmatic trials in oncology has increased significantly in the last decade, but PRECIS-2 is underutilized in the reporting of trials. Self-labelled pragmatic trials are not always highly pragmatic as defined by