Addressing Gaps in Knowledge of Management of Non-Small Cell Lung Cancer

Lung cancer is diagnosed in approximately 235,760 individuals in the United States each year, and 131,880 people die of the disease annually. Non-small cell lung cancer (NSCLC), which accounts for 84% of these cases, has a dismal 5-year survival rate of 18%, and most patients will develop progressive disease within 5 months of their final cycle of first-line classical doublet chemotherapy. The use of tumor histology in determining optimal treatment strategies and relevant molecular biomarkers has helped to refine the selection of novel therapies and improve outcomes for some patients. Although treatment selection based on tumor characteristics results in the most favorable outcomes by avoiding unnecessary, less effective, and more toxic therapies, implementation of molecular testing remains suboptimal. In addition, the rapid pace of clinical research has made it difficult for the multidisciplinary team to stay abreast of the latest treatment advances.

The knowledge gap in the optimal therapeutic approach for individual patients with NSCLC was identified in baseline data collected from i3 Health’s continuing medical education (CME)/nursing continuing professional development (NCPD)–approved visiting faculty meeting series titled Optimizing Personalized Care Plans for Patients With Advanced Non-Small Cell Lung Cancer, led by Mark A. Socinski, MD, Executive Medical Director of AdventHealth Cancer Institute; Maureen F. Zakowski, MD, Senior Faculty of Pathology, Molecular, and Cell Based Medicine at The Mount Sinai Hospital; and Victoria Sherry, DNP, CRNP, AOCNP®, Oncology Nurse Practitioner of the Abramson Cancer Center.

The activity was available online from February 19, 2020, until February 18, 2021; 689 learners began the activity, and 614 learners saw it through to completion. The majority (92%) of learners were registered nurses, followed by individuals with other professions (4%), physicians (3%), and nurse practitioners (2%). Participants had been in practice for an average of 16.1 years and saw an average of 18.1 patients with NSCLC per month. Learners were given a pretest prior to beginning the activity and a posttest consisting of the same questions following the activity’s conclusion.

The baseline assessment revealed a significant need for improvement in the knowledge of the optimal therapeutic approach to individual patients with NSCLC. Only 12% of participants recognized the side effect profile of brigatinib, and only 13.5% identified the efficacy of osimertinib. More participants, 62.7%, selected the correct management of afatinib-related diarrhea. In addition, 82.3% of participants recognized the inadequacy of distinguishing between small cell lung cancer (SCLC) and NSCLC, and 85.5% identified the efficacy of pembrolizumab.

Significant learning took place during the activity, based on the posttest scores. About 80% of participants, an additional 68%, recalled that of the anaplastic lymphoma kinase (ALK) inhibitors, brigatinib has the highest rate of pneumonitis. Also, 88.1%, an addition of almost 75%, correctly identified osimertinib as the correct choice to increase overall survival in a patient with locally advanced or metastatic NSCLC with exon 19 deletion and no prior systemic anticancer therapy. Almost 97% of participants knew that afatinib should be restarted at a reduced dose after afatinib-related diarrhea improves from grade 3 to grade 1 as a result of discontinuing afatinib, a learning gain of 34.2%. Just over 99% of participants, an addition of 16.9%, recognized that the distinction between SCLC and NSCLC is no longer sufficient in the choice of lung cancer treatment because adenocarcinoma and squamous cell carcinoma show different genetic profiles and respond to different treatments. Finally, 98.4% of participants knew that pembrolizumab monotherapy would be an appropriate treatment for a patient with metastatic nonsquamous NSCLC with a programmed death–ligand 1 (PD-L1) tumor proportion score of 80% and no epidermal growth factor receptor (EGFR) or ALK aberrations, a gain of 12.9%.

Learners’ performance on the pre- and post-activity assessment suggested that their competence improved regarding distinguishing different types of lung cancer, selecting appropriate therapies, and managing adverse events. Therefore, i3 Health has determined that the multidisciplinary team may benefit from future CME/NCPD–approved activities that provide further and updated education on lung cancer.

Upon completion of the activity, 87% of participants felt more confident in treating their patients with NSCLC, and 87% felt that the material presented would be used to improve the outcomes of their patients with NSCLC. 

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