Enhancing Competence in Evolving Treatment Options for Advanced Hodgkin Lymphoma
i3 Health has provided an educational activity that has alleviated clinician's knowledge gaps pertaining to the evolving landscape of advanced classical Hodgkin lymphoma (HL).
Hodgkin lymphoma is a malignancy involving the lymph nodes and lymphatic system. The American Cancer Society estimated in 2022 that there would be 8,540 new cases of HL in the United States, with 920 resulting in death. In contrast with other cancers whose risk increases with age, the risk for HL increases in patients between 15 and 30 years of age, decreases during middle age, and is followed by another peak in adulthood, older than 55. There are two main types of HL: classical HL, which accounts for 95% of cases in Western countries and is characterized by the presence of Reed-Sternberg cells, and nodular lymphocyte-predominant HL, which lacks these cells. The last few decades have seen significant progress in the management of patients with HL, leading to improved disease control and survival. However, optimizing remission rates and quality of life remain a challenge.
To address the knowledge gaps experienced by health care professionals regarding HL, i3 Health provided a continuing medical education (CME)– and nursing continuing professional development (NCPD)–approved activity, Novel and Emerging Treatment Strategies for Advanced Classical Hodgkin Lymphoma. Participants were led by two professionals in the field, Kami Maddocks, MD, Professor of Clinical Internal Medicine in the Division of Hematology at The Ohio State University, James Comprehensive Cancer Center and Kelly Brassil, PhD, RN, FAAN, Director of the Research and Real-World Evidence at Pack Health and Care Manager at MD Anderson Cancer Center. As well, this activity was supported by an independent educational grant from Seagen Inc.
A total of 886 individuals participated in the online enduring video viewpoint strategy session (VVSS) and podcast activity with 297 learners opting to complete the activity for credit. This activity was made available on i3 Health's website from June 30, 2021, until June 29, 2022. Most learners who attended were registered nurses (89%), followed by physicians (4%), nurse practitioners (3%), advanced practice nurses (1%), clinical nurse specialists (1%), physician assistants (1%), and those who chose "other" as their profession (1%). The average number of patients seen with HL in the participant population was eight per month, and the average number of years in practice was 16.
The baseline data collected revealed knowledge gaps in the following areas: discussing predictive and prognostic markers that can guide individualized management of advanced classical HL; assessing recent clinical trial data on novel treatment combinations and sequences for advanced classical HL; and devising strategies to monitor and manage the supportive care needs of both older and younger patients with advanced classical HL.
Participants in the VVSS activity were given a matching pretest and posttest at the beginning and end of the activity, respectively. The pretest revealed that only 16% of participants successfully identified treatment with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) as the appropriate next step for a patient with newly diagnosed stage III classical HL who is positive for residual disease identified by and an interim positron emission tomography (PET)/computed tomography (CT) scan after two cycles of ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine); 60% successfully identified brentuximab vedotin plus dacarbazine as the appropriate treatment for an older patient ineligible for standard chemotherapy with newly diagnosed stage IV classical HL, an Eastern Cooperative Oncology Group (ECOG) performance status of 1, and comorbidities of pulmonary disease and hypertension; 25% successfully identified patient-reported outcome collection for symptom burden as the clinical consideration associated with improved overall survival; 66% successfully identified that the proper way to manage toxicity for a patient with advanced classical HL who was being treated with ABVD and developed highly symptomatic grade 3 interstitial lung disease, is by removing bleomycin from the treatment regimen and initiating steroids; and 17% successfully identified ABVD as the treatment that would be the best option to preserve fertility for a patient with newly diagnosed HL who wishes to have children after she is done with treatment, given available data.
The posttest assessment revealed significant knowledge gains for each learning outcome. 78% more learners successfully understood interim PET/CT scan as a prognostic factor for escalated therapy; 32% more successfully understood brentuximab vedotin plus dacarbazine efficacy for older adults with newly diagnosed HL; 66% more successfully understood the inclusion of patient-reported outcomes in treatment planning; 33% more successfully understood management of grade 3 ABVD-associated interstitial lung disease; and 70% more successfully understood the use of ABVD to preserve fertility in younger patients with HL.
Upon completion of the activity, 87% of clinicians who completed the activity reported they felt more confident in treating their patients with HL, and 86% reported that 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 the topic of the rapidly updating and evolving field of advanced classical HL. Based on the data provided, i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide HL education on the following: predictive and prognostic markers to guide individualized management, recent clinical trial data on novel treatment combinations and sequences, and strategies to monitor and manage supportive care needs of both older and younger patients.
i3Health (2022). Novel and emerging treatment strategies for advanced classical Hodgkin lymphoma: activity outcomes report. Data on file.