Assessing Proficiency in Squamous Non–Small Cell Lung Cancer Management

i3 Health recently provided an online continuing medical education (CME)/nursing continuing professional development (NCPD)–accredited activity that has challenged the health care team’s proficiency in managing metastatic squamous non–small cell lung cancer (NSCLC).

Lung cancer is the second most common cancer in the United States between both men and women, with the American Cancer Society estimating a total of 238,340 new cases being diagnosed and 127,070 deaths occurring throughout 2023. Approximately 80% to 85% of all lung cancers are NSCLC. Squamous cell lung carcinoma is a distinct histologic subtype of NSCLC that accounts for approximately 25% to 30% of cases and is associated with approximately 30% shorter survival compared with other subtypes of the disease. Due to the plethora of alterations and mutations, for which targeted therapy approvals are uncommon in squamous cell NSCLC, treatment remains challenging. In addition, unique clinicopathologic characteristics and patient factors such as older age, advanced disease at diagnosis, and a higher incidence of comorbidities complicate effective treatment planning for patients with metastatic disease. Therefore, it is essential that members of the multidisciplinary team maintain a comprehensive understanding of the efficacy and safety profiles of emerging therapies to inform treatment selection and adverse event management.

To address the knowledge gaps experienced by clinicians regarding the management of metastatic squamous NSCLC, the online activity was made available via i3 Health’s website as a Video Viewpoint Strategy Session and as a podcast for learners’ preference and convenience, starting February 2, 2022, until February 1, 2023. Two leaders in the field led the activity: Mark G. Kris, MD, an Attending Physician on the Thoracic Oncology Service and the William and Joy Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center; and Victoria Sherry, DNP, CRNP, AOCNP®, a Nurse Practitioner at the University of Pennsylvania, Abramson Cancer Center.

Between the Video Viewpoint Strategy Session and the podcast, a total of 1,564 learners participated in the activity with 748 completing the activity for credit. Most learners were registered nurses and physicians, followed by nurse practitioners, physician assistants, and those who chose “other” as their profession. Learners had been in practice for an average of 18 years and saw an average of 20 patients with lung cancer per month.

The baseline data collected revealed knowledge gaps in the following areas: assessing patient and tumor characteristics that can inform individualized management plans in metastatic NSCLC; distinguishing emerging efficacy and safety data on novel cytotoxic therapies, immunotherapies, and monoclonal antibodies for metastatic squamous NSCLC; and appraising strategies to control treatment-related adverse events and optimize survivorship in patients with metastatic squamous NSCLC.

Participants were given a matching pretest and posttest at the beginning and end of the activity, respectively. The pretest data revealed that only 28% of participants understood that the majority of squamous cell carcinomas do not have targeted therapies; 51% successfully understood that pneumonitis is the most common grade 3 or 4 adverse event associated with pembrolizumab that a patient with advanced NSCLC should be monitored for during treatment; 40% successfully identified ipilimumab/nivolumab as the first-line treatment combination most likely to prolong overall survival for a patient with newly diagnosed lung squamous cell carcinoma; and only 25% successfully understood that targeted therapy with bevacizumab in combination with chemotherapy is not a safe and efficacious second-line treatment for squamous NSCLC.

The posttest assessment revealed significant knowledge gains for each learning outcome, with 63% more learners (91% total) successfully understanding patient counseling regarding targeted therapy availability for squamous NSCLC; 43% more (94% total) successfully understood adverse event monitoring for pembrolizumab; 36% more (76% total) successfully understood first-line treatment selection for squamous cell carcinoma; and 66% more (91% total) successfully understood bevacizumab safety for squamous NSCLC.

Upon completion of the activity, 84% of participants reported that they felt more confident in treating their patients with squamous NSCLC, and 86% reported they felt that the material presented would be used to improve the outcomes of their patients.

The data revealed by the posttest assessment affirm the effectiveness of online educational content pertaining to managing metastatic squamous NSCLC. Based on these data, i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide squamous NSCLC education on patient and tumor characteristics that can inform individualized management plans; emerging efficacy and safety data on novel cytotoxic therapies, immunotherapies, and monoclonal antibodies; and strategies to control treatment-related adverse events and optimize survivorship.


i3 Health (2023). Optimizing management of metastatic squamous non–small cell lung cancer: activity outcomes report. Data on file.

American Cancer Society (2023). Key statistics for lung cancer. Available at:

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