Supporting Educational Needs in Treatment of Advanced Non–Small Cell Lung Cancer

An educational enduring activity provided by i3 Health demonstrated significant learning outcomes in the selection of treatment for patients with anaplastic lymphoma kinase (ALK)–positive advanced non–small cell lung cancer (NSCLC). This activity was created to advise clinicians on the development of individualized treatment plans based on the best available evidence and emerging guideline recommendations.

Lung cancer is the second most common cancer in the United States, and the first most deadly, seeing more deaths than colon, breast, and prostate cancers combined. In 2022, the American Cancer Society (ACS) has estimated the United States alone will have 236,740 new cases of lung cancer—84% of which will be classified as NSCLC—and 130,180 of these cases will result in death. Although lung cancer is seeing a continued decrease in fatality year-by-year because of advances in early detection and treatment, as well as declining rates of smoking, implementation of molecular testing and individualized management plans remain suboptimal.

To address the educational need regarding treatment of NSCLC, i3 Health provided a continuing medical education (CME) and nursing continuing professional development (NCPD)–approved enduring activity and podcast, Expert Guidance on the Treatment of ALK-Positive Advanced Non–Small Cell Lung Cancer. The activity was led by Mark G. Kris, MD, Chief of the Thoracic Oncology Service and the William and Joy Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center, and Nathan Pennell, MD, PhD, Professor of Medicine at the Cleveland Clinic Taussig Cancer Center, with support by an education grant from Takeda Oncology.

A total of 648 learners participated in the online activity or listened to the podcast, with 102 completing the activity for credit. The activity was available online from October 22, 2020, until October 21, 2021. Most participants were registered nurses (77%) or physicians (10%), followed by pharmacists (2%), advanced practice nurses (1%), clinical nurse specialists (1%), and participants who selected “other” as their profession (9%). Attendees had been in practice for an average of 15.1 years and saw an average of 14 patients with NSCLC per month. Each learner was given a pretest prior to the beginning of the activity, followed by a posttest, which consisted of the same questions, upon the conclusion of the activity.

The baseline data collected demonstrated a significant shortcoming of knowledge in treatment of patients with NSCLC, including the following topics: competence in assessing the efficacy of novel agents for ALK-positive NSCLC, competence in determining treatment sequencing for ALK-positive NSCLC, and understanding the prevention of central nervous system (CNS) disease progression for ALK-positive NSCLC.

Prior to the start of the activity, the pretest revealed that while the majority (87%) of learners were able to recognize that brigatinib should prolong progression-free survival compared with crizotinib in patients with ALK-positive NSCLC, only 37% were able to correctly identify lorlatinib as the next-line ALK inhibitor that is most likely to be effective in patients who have previously developed resistance to two other ALK inhibitors. Additionally, only 36% of learners were able to correctly identify that, when compared to alectinib, crizotinib is less successful at preventing CNS disease progression for patients with previously untreated ALK-positive NSCLC.

Significant learning took place during the activity, as revealed by the posttest scores. Each topic saw a significant increase in successful identification of the correct answer. All learners, with an increase of 13% from pretest to posttest, were able to recognize the efficacy of brigatinib compared with crizotinib in patients with ALK-positive NSCLC; 71% of learners, an increase of 34%, were able to identify the efficacy of lorlatinib as a next-line ALK inhibitor; and 89% of learners, an increase of 53%, were successfully able to identify alectinib, when compared with crizotinib, as the better agent for preventing CNS disease progression in patients.

Upon completion of the activity, 87% of learners felt more confident in treating patients with NSCLC, and 87% felt that the material presented would be used to improve the outcomes of their patients.

These results confirm the effectiveness of the provided educational content and show the significant increase in learners’ knowledge and competence regarding strategies for the treatment of NSCLC. i3 Health has determined that the multidisciplinary team may benefit from CME/NCPD activities that provide NSCLC education on efficacy of novel agents, treatment sequencing, and prevention of CNS disease progression.


i3 Health (2021). Expert Guidance on the Treatment of ALK-Positive Advanced Non–Small Cell Lung Cancer: activity outcomes report. Data on file.

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

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