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Survey Reveals Practice Gaps in Managing Patients with CML and B-Cell Lymphomas

VBCC - Other
Phoebe Starr

New Orleans, LA—A 2-part survey presented at the 2013 Annual Meeting of the American Society of Hematology shows that 30% to 40% of community oncologists are not following guidelines or treating their patients with chronic myelogenous leukemia (CML), acute lymphoblastic leukemia (ALL), and B-cell lymphomas in line with expert opinion.

Survey results were presented by Kevin L. Obholz, PhD, Senior Managing Editor at Clinical Care Options, Reston, VA, and the survey was a joint effort of Clinical Care Options, the Annenberg Center for Health Sciences at Eisenhower, and the AXDEV Group.

The main findings include:

  • Approximately 40% of community oncologists were not up to speed on appropriate tests to monitor response in CML
  • Approximately 20% of oncologists are using bone marrow cytogenetics inappropriately
  • Only 30% of the oncologists who were surveyed could correctly name the molecular targets for 9 targeted therapies for B-cell lymphomas and ALL.

Part 1 included approximately 30 US board-certified oncologists who met the minimum eligibility requirements of treating at least 2 patients with CML, B-cell lymphoma, and ALL and at least 10 patients annually for the 3 diseases combined. Survey results and phone interviews with these participants elicited attitudes, behaviors, and barriers to adopting standards of care.

Part 2 was a quantitative study consisting of a 30-question online survey with practice-related questions to assess whether oncologists had adopted current standards of care; 121 community oncologists participated in the survey. Academic experts served as consultants for the study and provided expert opinion related to treatment and monitoring.

The responses revealed 9 core gaps in practice. Three were the most clinically relevant: challenges in selecting the first-line tyrosine kinase inhibitor (TKI) for chronic-phase CML; challenges in monitoring the response to first-line TKI therapy; and a lack of awareness and knowledge of promising investigational agents.

The current guidelines recommend imatinib, dasatinib, and nilotinib as first-line therapy. Dr Obholz noted that second-generation TKIs have shown superior efficacy and safety in clinical trials and that the expert consultants expressed a preference for second-line TKIs over imatinib in the survey.

“Experts seem to be integrating these data into practice, whereas our study findings suggest that many community physicians, particularly those that are less experienced, are not,” he continued.

The survey revealed the overuse of cytogenetic analysis for monitoring and the underuse of quantitative polymerase chain reaction. In addition, the oncologists’ knowledge was weak concerning thresholds for switching therapy.

The current guidelines indicate that molecular response at 3 months should be a milestone to consider a change in therapy, yet 42% of respondents were unsure or would not change therapy for patients experiencing a suboptimal response at that time point.

Only 50% of the respondents would change therapy if a complete cytogenetic response (CCyR) was not achieved at 12 months, yet this is a clear indication to switch therapy in treatment guidelines; 30% of the respondents indicated that they would not switch therapy when patients lost CCyR, another clear indication for a therapy switch.

Less than 30% of community oncologists were able to match the molecular targets for investigational agents in late stage of development, such as blinatumomab, fostamatinib, idelalisib, inotuzumab ozogamicin, and obinutuzumab.

“Our findings suggest a clear need for better education of community physicians caring for patients with relatively rare hematologic diseases. Community clinicians need expert-led education targeted to them as well as online tools that will help them understand how experts approach the care of these patients,” Dr Obholz suggested.

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Last modified: May 28, 2014
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