Differences in Treatment Decision-Making in Frontline Management of Lower-Risk Myelodysplastic Syndromes between Academic and Community Practice Settings: Results from a Nationwide Survey
Authors: Sekeres Mikkael A. , Venugopal Sangeetha , Chandhok Namrata S. , Watts Justin M. , Bradley Terrence , Taylor Justin , Sallman David , Xie Zhuoer , Padron Eric , Sullivan Shelby , Zyborowicz Emily , Carter Jeffrey , Heggen Cherilyn , Gurska Lindsay , Komrokji Rami S. 
Published: December 2024

Background

Lower-risk myelodysplastic syndromes (LR-MDS) are characterized by anemia in the majority of patients (pts), with more than half of pts becoming red blood cell (RBC) transfusion dependent. A goal of therapy is to alleviate cytopenia and its related complications. We assessed differences in clinical information used to guide LR-MDS treatment decision-making and barriers to treatment decisions between community and academic hematology/oncology providers in a nationwide survey.

Methods

During April 2024, a survey was sent twice two days apart to 29,192 hematology/oncology healthcare providers (HCPs), with survey access denied upon reaching the pre-defined goal (1% completion rate). Means and ranges are presented for summary statistics, and comparisons between groups were conducted using Chi-square statistics, with p-values &lt;.05 denoting significance.

Results

Among 133 HCPs, the median age was 50 years (range, 30-89), 20% Asian, 14% Hispanic, 12% Black, and 50% White. Most (67%) were physicians, 17% nurses, 5% nurse practitioners, and 8% pharmacists. Half practiced in a community setting, 37% in an academic setting, and 12% in an outpatient infusion center. Access to pathology and genetic facilities differed by practice setting, with 86% and 44% of academic HCPs but only 23% and 15% of community HCPs having a pathologist on staff or in-house genomics, respectively (both p&lt; .001). Academic HCPs identified considering the patient's molecular and cytogenetic profile (48%) and uncertainty about who the “right” pts for new therapies are (42%) as the biggest barriers to integrating frontline LR-MDS therapies, while community HCPs identified difficulty translating the latest guidelines and clinical data into practice (65%) and lack of expertise in the administration nuances and adverse event management for novel therapies (64%). Practice setting impacted perceived pts challenges, with academic HCPs reporting their pts' top challenges to considering frontline therapy as affording the cost of medication/ensuring insurance coverage (52%) and hesitation/uncertainty on initiating treatment (42%), contrasting to community HCPs reporting arranging caregiver support for transportation to/from appointments and/or disease management at home (71%) and living too far from treatment center for potential infusions and/or follow-up care (50%).

There were no significant differences between academic and community HCPs who reported treating LR-MDS pts in the frontline setting with erythropoiesis-stimulating agents, luspatercept, lenalidomide, hypomethylating agents, or immunosuppressive therapy; however, more academic providers reported use of regular RBC transfusions compared to community providers (33% vs 23%, p=.179), possibly indicating more advanced MDS. More academic than community HCPs reported using current transfusion requirements (82% vs 70%, p=.130) and hemoglobin (Hb) levels (40% vs 15%, p=.002) to inform the decision to start non-supportive care therapies. Of the HCPs who used transfusion requirements to inform treatment initiation, more community HCPs selected requiring 1 unit of blood every 2 months than academic HCPs (64% vs 10%, p&lt;.001), with more academic HCPs (28% vs 11% of community HCPs, p=.016) indicating 2 units of blood per month. Similarly, for those who use Hb level to inform treatment initiation, more academic than community HCPs (45% vs 26%, p=.023) indicated that a Hb &lt; 8 g/dL would warrant treatment initiation, while more community HCPs (38% vs 18%, p=.017) indicated a Hb of &lt; 9 g/dL.

Full findings from the survey, including sub-analyses by regional census data, will be presented.

Conclusions

Findings from this nationwide hematology/oncology provider survey revealed differences in factors considered for treatment initiation and barriers to treatment choice between academic and community HCPs who care for pts with LR-MDS. Of note, academic and community HCPs differed in their use of threshold Hb level or transfusion requirements to initiate treatment. Pts may be started on regular RBC transfusions, growth factors, or disease-modifying therapies at different timepoints of their disease depending on the practice setting.

Study Sponsor Statement

The study reported in this abstract was funded by an educational grant from Bristol Myers Squibb. The grantor had no role in the study design, execution, analysis, or reporting.