Abstract

Abstract 4270

Background

Clinical and translational research content in hematologic oncology is increasingly complex as new pathways and novel agents are investigated. Continuing oncology education (COE) for community-based oncologists (CBOs) must prioritize discussion of key new developments and clinical implications in order to optimize patient care.

Clinical investigators (CIs) at tertiary academic institutions usually focus on specific areas in their research and practice, and these individuals play an important role in defining medical oncology standards of care and often participate in COE. Many CBOs and their patients turn to CIs for advice, answers and second opinions, and we hypothesized that CIs could provide a unique perspective in prioritizing COE content.

This pilot project attempted to quantify and elucidate the experiences of investigators specializing in lymphoma/CLL (L) and multiple myeloma (MM), with the hope of gaining insight into current needs in COE that might directly impact patient care.

Methods

Between April 11 and May 16, 2012 we recruited 51 CIs (L: 26; MM: 25) to complete tandem questionnaires with about 60 items. Participants were provided a modest honorarium. As part of each survey and in order to document real-world experiences, CIs were asked to quantify how often they consult clinically with patients previously seen by another oncologist and how often they answer by phone or email case-related questions from CBOs. CIs also had the option to briefly describe up to 3 recent second opinion cases in which their recommendation differed significantly from that of a prior oncologist.

Finally, CIs were also asked to define their usual nonprotocol treatment approaches to a variety of important clinical scenarios (L: 31; MM: 26) and then provide on a 4-point analog scale their perception of the need for additional COE in each of these specific areas.

Results

Participating CIs have considerable experience with CBOs and CBO-managed patients, providing clinical second opinions a mean of 4.0 times per week (L: 3.3; MM: 4.7; range 0–13) and responding to email or phone case queries a mean of 8.5 times per week (L: 8.4; MM: 8.6; range 0–40).

CIs submitted a total of 89 case descriptions (L: 54; MM: 35) in which their treatment recommendation differed significantly from that of the prior oncologist. Specifically, in 19 of these cases (L: 13; MM: 6) the CI disagreed with the diagnosis, in 50 the choice of initial treatment differed (L: 28; MM: 22) and in 20 treatment for relapsed disease was questioned (L: 13; MM: 7).

The top-rated areas of education need are presented in the table below. In many of these issues, recent research developments have resulted in controversy and heterogeneity in treatment approaches.

Conclusions

This pilot project demonstrates that CIs regularly evaluate patients previously managed by CBOs and also provide long-distance second opinions by email and phone that in some instances result in divergent recommendations. These informative experiences contribute to an overall perception of specific education needs that could be very useful in planning COE and in development of performance improvement programs. Additional research is needed to confirm and expand these findings and determine if this quantitative and targeted approach to COE enhances patient care and measurable clinical outcomes.

NHL/CLL clinical decisions (n = 26)Mean% rating 4*MM clinical decisions (n = 25)Mean% rating 4*
Relapsed FL after R-CHOP ñ maintenance R 3.6 62 Implications of cytogenetics/FISH 3.8 76 
Choice of chemo with R in FL 3.5 58 Post-transplant maintenance 3.7 73 
Induction in younger patients with MCL 3.5 54 Subcutaneous bortezomib, neuropathy 3.6 64 
Induction for CLL, 17p deletion 3.4 46 Induction with acute renal failure 3.6 60 
Second-line FL after BR 3.4 46 Role of transplant 3.5 58 
NHL/CLL clinical decisions (n = 26)Mean% rating 4*MM clinical decisions (n = 25)Mean% rating 4*
Relapsed FL after R-CHOP ñ maintenance R 3.6 62 Implications of cytogenetics/FISH 3.8 76 
Choice of chemo with R in FL 3.5 58 Post-transplant maintenance 3.7 73 
Induction in younger patients with MCL 3.5 54 Subcutaneous bortezomib, neuropathy 3.6 64 
Induction for CLL, 17p deletion 3.4 46 Induction with acute renal failure 3.6 60 
Second-line FL after BR 3.4 46 Role of transplant 3.5 58 
*

1–4 ratings of education need for medical oncologists (1 = least need; 4 = greatest)

NHL = non-Hodgkin lymphoma; CLL = chronic lymphocytic leukemia; FL = follicular lymphoma; MCL = mantle-cell lymphoma; BR = bendamustine/rituximab

Disclosures:

Horwitz:Millennium: The Takeda Oncology Company: Research Funding; Seattle Genetics: Consultancy, Research Funding; Kyowa Hakko Kirin Co Ltd: Consultancy, Research Funding; Bristol-Myers Squibb Company: Consultancy; Celgene Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Allos Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Spectrum Pharmaceuticals: Consultancy, Research Funding. Lonial:Acetylon Pharmaceuticals Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb Company: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees; Merck and Company Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees; Millennium: The Takeda Oncology Company: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees; Onyx Pharmaceuticals Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees. Palumbo:Bristol-Myers Squibb Company: Consultancy; Celgene Corporation: Consultancy, Speakers Bureau; Millinnium: The Takeda Oncology Company: Consultancy, Speakers Bureau; Amgen, Inc: Speakers Bureau. Smith:Allos Therapeutics: Speakers Bureau; Cephalon Inc: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Millinnium: The Takeda Oncology Company: Speakers Bureau; Spectrum Pharmaceuticals Inc: Speakers Bureau; Genentech BioOncology: Speakers Bureau.

Author notes

*

Asterisk with author names denotes non-ASH members.