Significant Knowledge Gains Acquired for Treating Metastatic Breast Cancer

An educational enduring online activity provided by i3 Health has provided knowledge gains pertaining to enhancing treatment tolerability, adherence, and patient-centered care for metastatic breast cancer.

In the United States, breast cancer accounts for approximately 30% of cancer diagnoses among women and is the second-leading cause of cancer death. The American Cancer Society has estimated that in 2022 there will be 287,580 new cases of invasive breast cancer, with 43,250 of these cases resulting in death. Although many women benefit from regular screening as well as earlier and improved treatment, approximately 6% present with metastatic disease, and up to 30% with no initial lymph node involvement eventually develop metastatic disease. Despite progress in understanding the pathogenesis of metastatic breast cancer and advances in therapy, the 5-year overall survival rate remains only 27%.

To address the knowledge gaps experienced by medical professionals concerning metastatic breast cancer treatment tolerability, adherence, and patient care, i3 Health provided a nursing continuing professional development (NCPD)–approved activity, Metastatic Breast Cancer: Enhancing Treatment Tolerability, Adherence, and Patient-Centered Care. The activity was led by three professionals in the field: Mikel Ross, MSN, RN, AGPCNP-BC, OCN®, CBCN®, a Nurse Practitioner at Memorial Sloan Kettering Cancer Center; Sarah Donahue, MPH, NP, a Nurse Practitioner at the University of California San Francisco Health; and Constance Visovsky, PhD, RN, ACNP, FAAN, Director of the College of Nursing at the University of California San Francisco Health. This activity was supported by independent educational grants from Bristol Myers Squibb and Eisai.

A total of 685 learners participated, with 655 moving on to complete the activity for credit. Most learners were registered nurses (86%), followed by nurse practitioners (7%), clinical nurse specialists (3%), advanced practice nurse (1%), physicians (1%), and those who chose “other” as their profession (2%).

The baseline data collected revealed knowledge gaps in the following areas: identifying predictive and prognostic markers that can tailor treatment selection and goals to individual patients with metastatic breast cancer, evaluating the efficacy and safety profiles of novel therapies for human epidermal growth factor receptor 2 (HER2)–positive, HER2–negative, and triple-negative metastatic breast cancer, and assessing strategies to manage treatment-related adverse events, promote adherence to therapy, and ensure patient-centered metastatic breast cancer care.

Participants were given a matching-pairs pretest and posttest to evaluate knowledge gains throughout the activity. The pretest revealed that 26% of participants successfully identified tucatinib as the appropriate second-line treatment in combination with trastuzumab and capecitabine for patients with advanced unresectable or metastatic HER2-positive metastatic breast cancer previously treated with one or more anti–HER2-based regimens; only 15% successfully identified hyperglycemia as the most likely grade 3/4 adverse event to be experienced by a patient being treated with alpelisib/fulvestrant; 81% successfully identified that atezolizumab/nab-paclitaxel should prolong a patient’s overall survival compared with nab-paclitaxel alone; 17% successfully identified dose escalation of neratinib with as-needed loperamide as the strategy most likely to minimize the risk of treatment discontinuation due to diarrhea; and 19% successfully understood that a patient with HER2-positive metastatic breast cancer who is receiving fourth-line treatment with trastuzumab deruxtecan who has developed grade 1 interstitial lung disease (ILD) should resume treatment with trastuzumab deruxtecan at the original dose rather than with the dose reduced by one level after ILD resolution.

Significant learning took place as revealed by the posttest assessment: 50% more participants successfully identified the appropriate second-line treatment for a patient with HER2-positive metastatic breast cancer; 56% more understood alpelisib/fulvestrant adverse event monitoring; 8% more understood the efficacy of atezolizumab/nab-paclitaxel; 53% more understood neratinib/capecitabine–associated diarrhea management; and 40% more understood trastuzumab deruxtecan–associated interstitial lung disease management.

Upon completion, 88% of participants reported they felt more confident in treating patients with metastatic breast cancer, and 87% 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 the online educational content and show significant knowledge gains regarding enhancing treatment for metastatic breast cancer. i3 Health has determined that the multidisciplinary team may benefit from continuing medical education (CME)/NCPD activities that provide insights on predictive and prognostic markers to inform treatment selection, efficacy and safety of novel therapies, and strategies to manage adverse events, promote adherence, and ensure patient-centered care.


i3 Health (2022). Metastatic breast cancer: enhancing treatment tolerability, adherence, and patient-centered care: activity outcomes report. Data on file.

American Cancer Society (2022). Key statistics for breast cancer. Available at:

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