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Overcoming Knowledge Gaps in Thyroid Cancer Management

i3 Health has provided an educational activity that has challenged knowledge gaps experienced by clinicians regarding management and novel treatment options for differentiated and anaplastic thyroid cancer.

Thyroid cancer is one of the most prevalent cancers in the United States. The American Cancer Society estimates 43,720 new cases and 2,120 deaths from the disease in the United States over the course of 2023. Thyroid cancer is typically more aggressive in men than in women and becomes increasingly lethal in those above the age of 40. There are three primary subtypes of thyroid cancer, including differentiated—which encompasses papillary, follicular, and Hürthle cell diagnoses—medullary, and anaplastic. The differentiated subtype is the most common, accounting for approximately 95% of cases. The anaplastic subtype has the worst prognosis, with a 1-year survival rate of 20% and a disease-specific mortality rate of nearly 100%. Due to this poor prognosis, clinicians often struggle with the management of the disease, especially in its advanced and high-risk settings. It is vital that medical staff educate themselves on indications for novel therapies, their optimal starting times and dosing schedules, and their long-term safety profiles.

To address the knowledge gaps experienced by clinicians regarding differentiated and anaplastic thyroid cancer, i3 Health provided a continuing medical education (CME)– and nursing continuing professional development (NCPD)–approved activity, Rethinking the Management of Differentiated and Anaplastic Thyroid Cancers. The accredited activity was made available on i3 Health's website as a video and a podcast from July 30, 2021, until July 29, 2022. Two professionals in the field of thyroid cancers led this activity: Jochen Lorch, MD, a Professor of Hematology and Oncology at Northwestern University's Feinberg School of Medicine; and Carolyn Grande, CRNP, MSN, a Nurse Practitioner at the University of Pennsylvania's Abramson Cancer Center. The activity was supported by educational funding provided by Lilly.

A total of 1,046 learners participated in the activity, with 314 of them moving on to complete the activity for credit. Most participants were registered nurses (91%), followed by nurse practitioners, physicians, physician assistants, advanced practice nurses, and those who chose "other" as their profession. Of those who participated in the activity, the average number of years in practice was 17, and the average number of patients seen with thyroid cancers per month was 4.

The baseline data collected revealed knowledge gaps in the following areas: discussing the prognostic implications of rearranged during transfection (RET) and neurotrophic tyrosine receptor kinase (NTRK) alterations in advanced differentiated and anaplastic thyroid cancers; assessing emerging data on selective small molecule inhibitors, multikinase inhibitors, and immunotherapies for advanced differentiated and anaplastic thyroid cancers; and applying strategies to manage adverse events associated with selective small molecule inhibitors, multikinase inhibitors, and immunotherapies for advanced differentiated and anaplastic thyroid cancers.

Learners who completed the video activity were given a matching pretest and posttest at the beginning and end of the activity, respectively. The pretest assessment revealed that 21% of learners were able to successfully identify larotrectinib as a viable treatment option for a patient with previously diagnosed papillary thyroid cancer and a NTRK gene fusion without a known acquired resistance mutation, as identified by next-generation sequencing (NGS); only 11% successfully identified selpercatinib as a viable option to prolong progression-free survival in a patient with RET fusion–positive anaplastic thyroid cancer that is refractory to treatment with doxorubicin; 22% successfully identified daily blood pressure monitoring and recording as the most important counseling advice for a patient with papillary thyroid cancer being treated with pralsetinib; and 41% successfully identified holding spartalizumab and starting steroid therapy as the best course of action for a patient with anaplastic thyroid cancer who is being treated with spartalizumab and is experiencing grade 2 colitis.

The posttest assessment revealed significant knowledge gains for each learning outcome: 73% more learners (94%) were able to identify larotrectinib efficacy for metastatic NTRK-altered papillary thyroid cancer; 74% more (85%) were able to identify selpercatinib efficacy for RET fusion–positive anaplastic thyroid cancer; 74% more (96%) were able to identify the importance of monitoring blood pressure during treatment with pralsetinib; and 56% more (97%) understood management of grade 2 spartalizumab-associated colitis.

Upon completion of the activity, 83% of participants reported feeling more confident in treating their patients with thyroid cancer, and 85% reported feeling 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 the online educational content pertaining to novel treatment options and management of differentiated and anaplastic thyroid cancer. Based on the data provided, i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide thyroid cancer education on prognostic implications of RET and NTRK alterations; emerging data on selective small molecule inhibitors, multikinase inhibitors, and immunotherapies; and strategies to manage adverse events associated with selective small molecule inhibitors, multikinase inhibitors, and immunotherapies.

Resources

i3 Health (2022). Rethinking the management of differentiated and anaplastic thyroid cancers: activity outcomes report. Data on file.

American Cancer Society (2023). Key statistics for thyroid cancer. Available at: https://www.cancer.org/cancer/thyroid-cancer/about/key-statistics.html 


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