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Addressing Gaps in Knowledge of Best Practices in Metastatic Triple-Negative Breast Cancer

Of all women diagnosed with cancer in the United States, 30% have breast cancer, which is the second-leading cause of cancer death in this group. Many women have benefitted from regular screening as well as earlier and improved treatment; however, 6% of women present with metastatic disease, and 30% with no initial lymph node involvement will develop metastatic disease. Women with metastatic breast cancer have a poorer prognosis than the overall population of breast cancer patients, and research indicates that there is confusion among oncology providers over the optimal therapeutic approach for these patients. There is no globally accepted standard for prolonging survival, controlling symptoms, and maximizing quality of life for patients with pretreated breast cancer. In addition, the rapid pace of clinical research has made it difficult for oncology providers to maintain a working knowledge of the latest and most clinically relevant treatment advances.

Significant knowledge gaps regarding the optimal treatment for patients with triple-negative breast cancer (TNBC) were identified in baseline data collected from i3 Health's continuing medical education/nursing continuing professional development (CME/NCPD)-approved activity titled Implementing New Data and Evolving Standards in Metastatic Triple-Negative Breast Cancer, led by Sara M. Tolaney, MD, MPH, Assistant Professor of Medicine at Harvard Medical School, and Sara A. Hurvitz, MD, Assistant Professor of Medicine at David Geffen School of Medicine at UCLA.

The activity was available online from April 1, 2019, to March 31, 2020, and it was viewed by 701 learners, 594 of whom were registered nurses (92%). In addition, 29 nurse practitioners (4%), 10 physicians (2%), 12 others (2%), and one pharmacist (<1%) completed the activity. Thirty-one percent of participants had been in practice for 20 or more years, and participants saw an average of eight patients with TNBC per month. Learners were given a pretest prior to beginning the activity and a posttest consisting of the same questions at the activity's conclusion. Of the 701 learners who viewed the activity, 646 saw it through to completion.

The baseline assessment demonstrated significant need for improvement in the knowledge of optimal therapies for and management of TNBC. Only 26% of participants identified that carboplatin would improve progression-free survival compared with docetaxel in a patient with BRCA-mutated metastatic TNBC; only 10.6% recognized that anemia is the most common grade 3/4 adverse event associated with talazoparib; and only 21.3% knew that eribulin/pembrolizumab was associated with a median overall survival of 17.7 months in patients with previously untreated metastatic TNBC. Slightly more (40.5%) participants knew that the expected median progression-free survival for a 41-year-old woman with recurrent BRCA-mutated metastatic breast cancer treated with talazoparib would be 8.6 months, and most (92.3%) participants recognized that patients diagnosed with TNBC at 60 years of age or younger should undergo genomic testing for BRCA mutations.

Significant learning took place during the activity. Nearly 70% more learners (96% vs 27%) correctly identified that carboplatin would improve progression-free survival compared with docetaxel in patients with BRCA-positive disease. Fifty percent more learners (90% vs 41%) recognized that the expected median progression-free survival for a 41-year-old woman with recurrent BRCA-mutated metastatic breast cancer treated with talazoparib would be 8.6 months. Eighty percent more learners (90% vs 11%) recalled that anemia is the most common grade 3/4 adverse event associated with talazoparib. Almost 70% of learners (89% vs 21%) knew that eribulin/pembrolizumab was associated with a median overall survival of 17.7 months in patients with previously untreated metastatic TNBC. Knowledge of whether a patient should undergo genomic testing for BRCA mutations, which was high to start, improved by 8% (100% vs 92%).

Learners' performance on the pre- and post-activity assessment suggested that their competence improved regarding TNBC risk assessment and staging, as well as surrounding the efficacy and safety of TNBC therapies. i3 Health has determined that the multidisciplinary team may benefit from future CME/NCPD–approved activities that provide education on TNBC risk assessment, staging, and efficacy and safety of novel therapies.

Upon completion of the activity, 90% of participants felt more confident in treating their patients with TNBC, and 90% felt that the material presented would be used to improve the outcomes of their patients. 


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