Due to the advances in treatment options for metastatic gastric cancer in recent years, oncology physicians and nurses can individualize treatment selection for patients by considering pathologic and molecular characteristics and emerging efficacy and safety data on novel therapies.
Baseline data collected from i3 Health's continuing medical education (CME)/nursing continuing professional development (NCPD)–approved visiting faculty meeting series titled Challenges and Opportunities in Metastatic Gastric Cancer revealed that while health care professionals were fairly well versed in some topics related to metastatic gastric cancer, some knowledge gaps existed surrounding the optimal therapeutic approach for individual patients.
Of the 798 learners who took the pretest and began the activity, which was available online from March 19, 2019, to March 18, 2020, 748 saw it through to completion. The learners who completed the activity were primarily registered nurses (93.2%), followed by nurse practitioners (3.5%), physicians (2.1%), physician assistants (0.3%), and several individuals who selected "other" for their profession (0.9%). Participants saw an average of 15.3 patients with gastric cancer per month, and more than 60% of participants had been in practice for over 11 years. Learners were given a pretest prior to beginning the activity and a posttest, consisting of the same questions as the pretest, following the activity's conclusion.
At baseline, most learners (87.3%) correctly identified that a patient with a high microsatellite instability (MSI) status would be a candidate for immune checkpoint inhibitor therapy after progressing with fluoropyrimidine and oxaliplatin. Checkpoint inhibitor pembrolizumab is approved for second-line treatment of MSI-high gastric cancer. Most learners (70.4%) also recognized that a patient receiving fluoropyrimidine/oxaliplatin for metastatic gastric adenocarcinoma should have trastuzumab added to her current chemotherapy once her immunohistochemistry test comes back positive for HER2 overexpression. In addition, many learners (75.8%) correctly identified that neutropenia was the grade 3 or higher adverse effect that a patient receiving trifluridine/tipiracil would most likely experience.
However, the baseline assessment also showed significant knowledge gaps. Only 39.8% of learners correctly identified that a patient receiving ramucirumab/paclitaxel for metastatic gastric cancer who develops grade 3 hypertension should have her treatment with ramucirumab temporarily suspended for severe hypertension and discontinued for hypertension that cannot be medically controlled. In addition, only slightly more than half of learners (54.9%) correctly identified that the estimated median overall survival for a patient receiving trifluridine/tipiracil for metastatic gastric cancer refractory to two lines of previous therapy was 5.7 months.
The post-activity assessment showed that significant learning took place during the activity with respect to all topics. Learners showed a 46% improvement in knowledge that ramucirumab should be temporarily suspended for severe hypertension (39.8% vs 85.4%) and a 37% improvement in identification of the correct median overall survival for a patient receiving trifluridine/tipiracil for metastatic gastric cancer (54.9% vs 91.5%). Improvement was even seen on topics for which baseline assessment scores were fairly high, with 25% more learners now knowledgeable that trastuzumab should be added to chemotherapy for HER2–overexpressing metastatic gastric adenocarcinoma (70.4% vs 95.0%), 10% more learners able to identify that MSI-high status makes a patient a good candidate for immune checkpoint inhibitor therapy (87.3% vs 97.6%), and 11% more learners able to correctly identify neutropenia as the most likely grade 3 or higher adverse effect a patient receiving trifluridine/tipiracil for metastatic gastric cancer would experience (75.8% vs. 87.0%).
Learners' performance on the post-activity assessment suggests that their competence improved regarding biomarkers for first- and second-line treatment selection, treatment-related adverse event management, and efficacy and safety of novel therapies. However, gaps between actual practice and evidence-based practice remained evident, particularly with regard to treatment-related adverse event management. i3 Health has determined that the multidisciplinary team of participants may benefit from future CME/NCPD-approved activities that provide gastric cancer education regarding biomarkers for treatment selection, efficacy and safety of novel therapies for gastric cancer, and the management of gastric cancer therapy–related adverse events.
As a result of the activity, 89% of participants felt more confident in treating their patients with gastric cancer, and 89% felt that the material presented would be used to improve the outcomes of their patients.