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Addressing Knowledge Gaps in the Treatment of Metastatic Colorectal Cancer

An educational activity provided by i3 Health has revealed significant learning gains in the knowledge of novel treatment strategies for metastatic colorectal cancer (mCRC). The activity was presented virtually at the American Society of Clinical Oncology (ASCO) Annual Meeting in 2020 and was made available as an enduring online activity.

Colorectal cancer is the second leading cause of cancer death among women and men in the United States and is the third most diagnosed cancer worldwide. In the United States, there are an estimated 151,030 new cases annually, with an estimated 52,580 resulting in death. If diagnosed and treated early at a localized stage, colorectal cancer can have an estimated 5-year survival rate of 91%. However, because colorectal cancer initially exhibits no symptoms—making routine screenings suboptimal—and because polyps can be hard to identify during a colonoscopy without the use of dye to highlight them, many cases go unnoticed until later stages.

To address the educational need regarding novel treatment strategies for mCRC, i3 Health provided a continuing medical education (CME)–approved enduring virtual ancillary educational activity, Exploring Novel Treatment Strategies for Metastatic Colorectal Cancer, led by Jaffer A. Ajani, MD, Professor in the Department of Gastrointestinal Medical Oncology at the University of Texas MD Anderson Cancer Center, with commercial support from Amgen.

A total of 441 learners participated in the activity, with 351 completing the activity for credit. Fifty-nine of these learners participated in the live webinar presented at ASCO on May 31, 2020, with the remainder participating in the enduring activity, which was available online from June 5, 2020, until June 4, 2021. Most participants were registered nurses (80%) and physicians (9%), followed by nurse practitioners (3%), pharmacists (2%), and participants who selected "other" as their profession (6%). Attendees had been in practice for an average of 15.8 years and saw an average of 16 patients with CRC per month. Each learner was given a pretest prior to the beginning of the activity, followed by a posttest, which consisted of the same questions, upon the conclusion of the activity.

The baseline data collected demonstrated a significant shortcoming of knowledge in the diagnosis and treatment of patients with mCRC, including the following topics: distinguishing predictive and prognostic markers that can refine individualized treatment of mCRC, applying current and emerging data on novel therapies in clinical management, and appraising recent data on novel combination and sequential treatment strategies.

Prior to the start of the activity, the pretest revealed that only 19% of learners recognized that first-line treatment with cetuximab/FOLFIRI (folinic acid/fluorouracil/irinotecan) would not prolong overall survival compared with FOLFIRI alone for patients with right-sided RAS–wild-type (RAS-WT) mCRC; only 23% were able to successfully identify that first-line treatment with panitumumab/FOLFOX (folinic acid/fluorouracil/oxaliplatin) would not prolong overall survival compared with FOLFOX alone for patients with RAS-WT right-sided mCRC; just over half of learners (58%) were able to recognize that first-line treatment with panitumumab/FOLFOX should prolong overall survival compared with bevacizumab/FOLFOX when used for patients with RAS-WT left-sided mCRC; 25% were able to successfully identify cetuximab/encorafenib as the better treatment option for a patient with previously treated BRAF V600E–mutated mCRC; and only 48% of learners were able to successfully identify an anti–programmed cell death protein 1 (PD-1) or anti–programmed death ligand 1 (PD-L1) therapy as the appropriate initial therapy for a patient mismatch-repair–deficient (dMMR) RAS-mutant left-sided mCRC.

Significant learning took place during the activity, as revealed by the posttest scores. In 4 out of 5 topics on the posttest, more than 90% of the learners were able to identify the correct answer with statistically significant learning increases on each topic (P<0.0000001). Learning gains were revealed by a 79% increase in knowledge of expected overall survival with first-line cetuximab/FOLFIRI compared with FOLFIRI alone in patients with RAS-WT right-sided mCRC; a 73% increase in knowledge of expected overall survival with first-line panitumumab/FOLFOX compared with FOLFOX alone in patients with RAS-WT right-sided mCRC; a 39% increase in knowledge of the likelihood of overall survival with first-line panitumumab/FOLFOX compared with bevacizumab/FOLFOX for patients with RAS-WT left-sided mCRC; a 64% increase in identification of cetuximab/encorafenib as the better treatment option for a patient with previously treated BRAF V600E–mutated mCRC; and a 43% increase in identification of an anti–PD-1 or anti–PD-L1 therapy as the appropriate initial therapy for a patient with mismatch-repair–deficient RAS-mutant left-sided mCRC.

Upon completion of the activity, 80% of participants felt more confident in treating their patients with CRC, and 80% also reported that they felt that the presented material would be used to improve the outcomes of their patients.

These results confirm the effectiveness of the provided educational content and show the significant increase in learners' knowledge and competence regarding strategies for the treatment of mCRC. i3 Health has determined that the multidisciplinary team may benefit from CME/nursing continuing professional development (NCPD) activities that provide CRC education on predictive and prognostic markers, novel therapeutic agents, and novel combination and sequential treatment strategies.

References

i3 Health (2021). Exploring Novel Treatment Strategies for Metastatic Colorectal Cancer: activity outcomes summary report. Data on file.

American Society of Clinical Oncology (2022). Colorectal cancer guide. Available at: https://www.cancer.net/cancer-types/colorectal-cancer/introduction


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