Educational Needs in the Management of Relapsed/Refractory Follicular Lymphoma

Follicular lymphoma, an indolent, difficult-to-treat B-cell malignancy, is complicated by evolving disease subtypes. Patient outcomes can be hampered by the failure of the multidisciplinary team to establish consensus on the optimal timing, schedule, and length of follicular lymphoma treatment. In addition, the rapid pace of research makes it difficult to stay abreast of the latest and most clinically relevant therapies. This educational gap in the treatment and management of follicular lymphoma was identified in the baseline data collected from i3 Health’s continuing medical education (CME)-approved visiting professor lecture series New Directions in the Management of Relapsed/Refractory Follicular Lymphoma with Ajay K. Gopal, MD, Professor of Medicine at the Seattle Cancer Care Alliance, Reem Karmali, MD, MS, Associate Professor of Medicine at Northwestern Memorial Hospital, Connie Lee Batlevi, MD, PhD, Medical Oncologist at Memorial Sloan Kettering Cancer Center, Sarah Rutherford, MD, Assistant Professor of Medicine at Weill Cornell Medical College, Loretta J. Nastoupil, MD, Associate Professor of Medicine at MD Anderson Cancer Center, and Anas Younes, MD, Professor of Medicine at Memorial Sloan Kettering Cancer Center.

A total of 171 learners engaged in the activity at live meetings, and 93 completed the activity for credit. The activity was presented at 10 live meetings held between September 27, 2019, and March 16, 2021. The majority of learners were physicians (57%), followed by fellows (24%), individuals who selected “other” for their profession (7%), registered nurses (6%), nurse practitioners (2%), pharmacists (2%), and physician assistants (2%). Participants had been in practice for an average of 6.9 years and saw an average of six patients a month with follicular lymphoma. 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 demonstrated a significant shortfall in knowledge in assessing risk classification, as well as emerging efficacy and safety data on novel therapeutic approaches for relapsed/refractory follicular lymphoma: only 6% of learners correctly identified the likelihood that idelalisib will improve the lymphadenopathy of a 60-year-old woman with refractory follicular lymphoma as 90%; only 28% could identify that transient hyperglycemia was the most likely adverse event of copanlisib treatment for relapsed follicular lymphoma; and only 15% correctly assessed the risk of a 63-year-old-woman with relapsed stage III follicular lymphoma, a hemoglobin level of 9.5 g/dL, and normal levels of lactate dehydrogenase and beta-2-microglobulin, as high according to the Follicular Lymphoma International Prognostic Index. Learners had more knowledge of second-line therapy with 52% correctly choosing rituximab for a 67-year-old man with follicular lymphoma that relapses after one line of systemic therapy. An even higher proportion of learners, 82%, knew that lenalidomide/rituximab would improve the progression-free survival of a 70-year-old man with relapsed follicular lymphoma compared with rituximab alone.

Significant learning took place during the activity, as revealed by the learners’ performance on the posttest. Learners demonstrated a learning gain of 48% regarding idelalisib efficacy for lymphadenopathy; a learning gain of 45% regarding copanlisib adverse events management; a learning gain of 30% in assessing risk classification with the Follicular Lymphoma International Prognostic Index; a learning gain of 17% in choice of second-line therapy for follicular lymphoma; and even a 2% gain in the lenalidomide/rituximab efficacy for relapsed follicular lymphoma.

Learners’ performance on the pre- and post-activity assessments suggested that their competence improved regarding the efficacy and safety of novel first- and second-line therapies, management of relapsed/refractory follicular lymphoma, and risk factors used to classify follicular lymphoma disease stage. Therefore, i3 Health has determined that the multidisciplinary team may benefit from future CME–approved activities that provide further and updated follicular lymphoma education.

Upon completion of the activity, 92% of participants felt more confident in treating their patients with follicular lymphoma, and 93% felt that the material presented would be used to improve the outcomes of their patients. 

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