Enhanced Proficiency for Treatment Paradigms in Advanced Hepatocellular Carcinoma

Liver cancer is the sixth most common tumor type and the third leading cause of cancer-related death worldwide. The American Cancer Society estimates that in the United States, 41,210 new cases will be diagnosed and 29,380 people will die of the disease this year alone. Hepatocellular carcinoma is the most common type of liver cancer, accounting for nearly three-quarters of all liver cancers in the US. Patients with HCC continue to have a dismal outlook, due in part to most tumors being diagnosed at advanced stages, for which there is a dearth of effective therapies. Without treatment, most patients with advanced HCC survive less than six months. Due to this, it is vital that members of the multidisciplinary team maintain proficiency and address their knowledge gaps surrounding treatment paradigms and management of advanced HCC.

To address the knowledge gaps experienced by clinicians concerning the treatment of advanced HCC, i3 Health made available a continuing medical education (CME)/nursing continuing professional development (NCPD)–accredited live meeting series between January 23, 2020 and August 17, 2022. Throughout the duration of the activity, 10 meetings were held throughout the country at Veterans Affairs (VA)/Department of Defense (DoD) medical centers in Delaware, Wisconsin, Pennsylvania, Florida, and New York. The activity was led by four key leaders in the field of HCC: Hashem El-Serag, MD, MPH, Chair of this activity and Professor of Medicine-Gastroenterology at Baylor College of Medicine; David Kaplan, MD, MSc, Director of Hepatology at Corporal Michael J. Crescenz, Veteran Affairs (VA) Medical Center; Tamar Taddei, MD, Professor of Internal Medicine at Yale School of Medicine; and Adnan Said, MD, MS, Professor of Gastroenterology and Hepatology at the University of Wisconsin School of Medicine and Public Health.

A total of 299 learners participated in the activity and completed the activity for credit. Most learners were physicians (n=185), followed by nurse practitioners (n=28), physician assistants (n=15), pharmacists (n=10), physician students (n=7), registered nurses (n=3), and those who chose "other" as their profession (n=51). The average number of patients seen with HCC per month by learners was 13, and the average number of years in practice was 14.

The baseline data collected revealed knowledge gaps in the following areas: identifying prognostic factors that can inform personalized care plans for patients with HCC, assessing emerging data on the use of novel therapies in first-line, second-line, and salvage therapy for advanced HCC, and applying strategies to manage adverse events and help patients with advanced HCC achieve their goals of therapy.

Participants were given a matching pretest and posttest at the beginning and end of the activity, respectively. The posttest assessment revealed significant knowledge gains for each learning outcome; an 18% increase in knowledge concerning disease staging according to the Barcelona Clinic Liver Cancer (BCLC) criteria (pretest 48% versus posttest 66%); a 14% increase in knowledge concerning lenvatinib efficacy for untreated advanced HCC (pretest 61% versus posttest 75%); a 7% increase in knowledge concerning pembrolizumab efficacy for advanced refractory HCC (pretest 51% versus posttest 58%); a 28% increase in knowledge concerning cabozantinib efficacy for advanced refractory HCC (pretest 27% versus posttest 55%); and a 15% increase in knowledge concerning adverse event management for cabozantinib (pretest 29% versus posttest 44%).

Upon completion of the activity, 80% of participants reported that they felt more confident in treating their patients with advanced HCC, and 80% 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 the treatment of advanced HCC. Based on these data, i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide HCC education on prognostic factors to inform personalized care plans, emerging data on the use of novel first-line, second-line, and salvage therapies, and strategies to manage adverse events and help patients achieve their goals of therapy.

Resources

i3 Health (2022). Understanding evolving treatment paradigms in advanced hepatocellular carcinoma: activity outcomes report. Data on file.

National Cancer Institute (2023). Liver cancer causes, risk factors, and prevention. Available at: https://www.cancer.gov/types/liver/what-is-liver-cancer/causes-risk-factors#:~:text=Worldwide%2C%20liver%20cancer%20is%20the,deaths%20in%20the%20United%20States