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Tara Herrmann
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-025 - Biomarker Testing in Advanced NSCLC: A Simulation-Based Assessment of Medical Oncologists (ID 7982)
09:30 - 09:30 | Presenting Author(s): Tara Herrmann
- Abstract
Background:
The past several years have seen a number of changes in standards of care for NSCLC, challenging oncologists to integrate evolving diagnostic paradigms into practice. A study was conducted using simulation-based technology to assess medical oncologists’ current performance in ordering biomarker testing and diagnosing advanced NSCLC.
Method:
A virtual patient simulation (VPS) consisting of 2 patient cases was made available online via a website dedicated to continuous professional development. The VPS platform allowed oncologists to assess the patients and choose from an extensive database of diagnostic possibilities matching the scope and depth of practice. Clinical decisions made by participants in the VPS were analyzed using a sophisticated decision engine, and instantaneous, formative clinical guidance employing the current evidence-base and expert faculty recommendations were provided. After CG, oncologists had a second chance to address errors of omission. Data were collected between 1/29/2016 and 11/29/2016.
Result:
197 oncologists fulfilled the participation criteria for completing the VPS. Assessment of their clinical decisions prior to CG revealed: · In a patient with newly diagnosed advanced NSCLC, 21% of oncologists did not order histopathology to determine subtype while 58% failed to order EGFR mutational testing Moreover, 30% ordered ROS1-translocation FISH testing and 39% PD-L1 IHC testing. Interestingly, although no approved targeted agent exists for MET amplified-, RET-translocated-, or BRAF-mutated NSCLC, 17%-28% ordered these molecular tests. · In a patient with EGFR-mutated NSCLC who had progressed on first line EGFR TKI, 40% did not order testing for T790M. Moreover, 40% ordered PD-L1 staining. Consistent with findings from the first case, between 11%-18% ordered testing for rarer mutations for which patients may qualify for a clinical trial.
Conclusion:
Histopathologic and biomarker testing are critical elements for selecting the most appropriate regimen for patients with advanced NSCLC across the continuum of care. Our analysis of current practice using a VPS platform that immerses and engages the clinician for an authentic, practical and consequence-free experience demonstrates that there is variability in biomarker testing by oncologists. In addition, our findings demonstrate a continued need to educate oncologists about prioritizing biomarker tests in order to select the most appropriate regimen for a patient with advanced NSCLC.
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P1.01-068 - Impact of Case-Based CME on Physician Performance in the Diagnosis and Management of NSCLC (ID 9431)
09:30 - 09:30 | Author(s): Tara Herrmann
- Abstract
Background:
Lung cancer is the leading cause of cancer-related mortality in the United States. Over the last decade an improved understanding of the pathways that drive malignancy and disease progression have fundamentally altered the NSCLC treatment paradigm. We sought to determine if participating in a case-based online educational intervention related to NSCLC diagnosis and management improved the clinical decision-making of oncologists and pathologists in the US.
Method:
Oncologists participated in an innovative online CME activity using branching logic that assessed clinical decisions in management of patients with NSCLC and provided tailored feedback. Two patient cases were presented and clinicians were assessed on answers to multiple-choice questions pre- and post- education. If first attempt answers were incorrect, clinicians received feedback and clinical consequences for their choices, and provided a second opportunity to answer. The CME activity launched May 5, 2016 and data were collected through June 6, 2016.
Result:
For oncologists (n=149), between 52% and 70% answered clinical decision questions correctly on the first attempt, while 27% to 94% of pathologists (n=44), answered correctly . After consequence-based feedback, between 12% and 41% of both oncologists and pathologists improved their decision-making. Specific improvements seen include: 20% oncologists and 23% pathologists increased their ability to identify the need to order IHC staining to identify the tumor’s histopathology 23% more oncologists and 29% more pathologists selected the most appropriate regimen for a patient with adenocarcinoma without actionable mutations after 30% of oncologists and 41% pathologists increased in their ability to select the most appropriate therapy for a patient who has progressed on a first-line regimen based on prior treatment and the PD-L1 status of their tumor
Conclusion:
This innovative, case-based CME activity using branching logic with tailored consequence-based feedback improved clinical decision-making in management of patients with NSCLC to drive learning. It is anticipated that improved clinical decisions among oncologists and pathologists in diagnosis and management of NSCLC will lead to translation in practice and better patient outcomes. Future education using a similar design could be used to translate ongoing developments in NSCLC into clinical decisions for comprehensive management of NSCLC.
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P2.07 - Immunology and Immunotherapy (ID 708)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.07-036 - Appropriate Use of Immune Checkpoint Inhibitors in Advanced NSCLC: Effectiveness of Unique Case-Based Education on Clinical Decision-Making (ID 9441)
09:30 - 09:30 | Presenting Author(s): Tara Herrmann
- Abstract
Background:
The past several years have witnessed unparalleled changes in treatment for patients with advanced NSCLC. Although these changes present significant hope, it remains unclear if oncologists have been able to stay current on the breadth of practice changes, and effectively incorporate evidence-base into practice. The objective of this study was to evaluate oncologists’ competence regarding the use of immune checkpoint inhibitors (ICI) in the management of advanced NSCLC and the impact of education on narrowing gaps in clinical practices.
Method:
An online education environment that employed video vignettes to simulate practice, presented 3 CME-certified case activities, each illustrating a clinical challenge. Questions regarding point-of-care decisions were posed as a means of testing the oncologist’s ability to make treatment decisions and to communicate effectively with patients who have NSCLC. These case activities included patients with non-squamous and squamous NSCLC and who exhibited adverse events. For each activity, an assessment instrument using case-based, multiple-choice questions was administered to compare each oncologist’a responses to questions posed before and after the education was presented. Confidentiality of respondents was maintained, responses were de-identified, and aggregated prior to analyses. McNemar's χ[2] test compared learners' responses from pre- to post-assessment. The activities were launched between October 21, 2016, and December 6, 2016, and data were collected through April 26, 2017.
Result:
2,399 oncologists participated in at least one of the 3 activities. Responses of 325 participants who answered all questions during the study period were included. Upon completion of the activities, an improvement was observed in oncologists’ ability to: Identify the correct evidence-based regimen including when to use ICIs for a patient that has progressed on first line therapy (76% vs 98%, P <0.001) Counsel patients on the expected effectiveness of ICI in patients (69% vs 89%, P <0.001) Select the most appropriate monitoring strategy to detect immune-related adverse events in patients receiving an ICI (52% vs 78%, P <0.001) Order appropriate tests to identify the etiology of symptoms that appear during treatment (60% vs 92%, P <0.001) Properly manage immune-related adverse events due to treatment with ICI (67% at baseline to 88% post education, P =0.001) In addition, comfort with prescribing ICIs also increased.
Conclusion:
Use of online, case-based CME utilizing video vignettes to simulate practice improved competence among participating oncologists, demonstrating that online CME can be an effective tool to improve clinical decision-making in the rapidly changing environment of advanced NSCLC disease management.
