Specific Education, Training Needs Required for Appropriate Therapeutic Decision-Making for Women with HR-Positive, HER2-Negative Breast Cancer

A new survey shows that the right education, training needs, and strategies are essential to promote the best evidence-based management processes involving therapies for women with hormone-receptor (HR)-positive, or human epidermal growth factor receptor 2 (HER2)-negative breast cancer. The results are based on specific challenges and variable practices that have been recently reported on the implementation of cyclin-dependent kinase 4/6 (CDK4/6) inhibitor therapies.

The research was authored by experts from the Dana-Farber Cancer Institute, Baylor University Medical Center, and PRIME Education, and was presented at the 2019 San Antonio Breast Cancer Symposium in San Antonio, Texas.

CDK 4/6 inhibitors offer the potential to significantly improve outcomes for women with HR-positive, HER2-negative breast cancer. However, appropriate evidence-based uses of CDK4/6 inhibitor therapies depend on effective education and implementation strategies, according to the researchers.

Baseline surveys were given to medical oncologists and clinical staff in 2 large United States health care systems, which included items for assessing participants’ challenges, barriers, and education/training needs in managing patients with HR-positive/HER2-negative breast cancer. In addition, researchers audited 100 electronic medical records (EMRs) of women with HR-positive/HER2-negative breast cancer in each of the 2 systems.

Oncology teams were then able to participate in continuing medical education and quality improvement activities, in which national leaders in breast cancer research and education presented the baseline survey results and EMR-audit feedback. This helped guide participants in developing targeted action plans to overcome barriers and to close clinical gaps.

The results showed that a large percentage of the respondents indicated low levels of satisfaction with current CDK4/6 inhibitor treatment algorithms (40%), scheduling of patient follow-up visits (35%), team-based coordination of care (15%), and protocols for supportive care (15%).

The most commonly reported challenges and barriers in managing patients with HR-positive/HER2-negative breast cancer included identifying women who would benefit from CDK4/6 inhibitor therapies, monitoring patients for disease progression, and receiving support from administrative leadership.

When asked about facilitators to reducing patient risks of discontinuing CDK4/6 inhibitors due to toxicity, the most common responses were increasing interprofessional collaboration and care coordination, and providing education about adverse events to patients, caregivers, and oncology team members.

Some of the action plans developed by the participants in the continuing medical education/quality improvement activities included establishing protocols and EMR tracking mechanisms for monitoring patients using CDK4/6 inhibitor therapies; tracking pharmacy dispensing of CDK4/6 inhibitor therapies; and documenting patient characteristics such as staging, menopausal status, and progression to guide individualized treatment decision making.

REFERENCE

Tolaney S, O’Shaugnessy JA, Crawford R, et al. Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclic-dependent kinase 4/6 inhibitors [Poster P1-15-05]. Presented at: San Antonio Breast Cancer Symposium 2019. December 11, 2019. San Antonio, TX.