Abstract P6-16-08: Using continuing professional development (CPD) as an investigative tool to improve clinical practice and interdisciplinary team treatment
Authors: Harnden K , Hester D 
Published: May 2019

Background:

Continued and rapid evolution of diagnosis and staging methods along with the development of new treatments has changed the decision-making process for cancer patients into a more complex task. In breast cancer, quality measures related to sentinel lymph node biopsy (SLNB), axillary dissection (AD), HER2 testing and use of HER2-targeted therapy, provide parameters for assessing care quality. We assessed the influence of quality improvement education (QIE) on alignment with BC quality indicators.

Methods:

39 members of the interprofessional team at Inova (an integrated care network of 5 hospitals) participated in the QIE components. For a baseline Inova provided deidentified electronic medical records (EMR) data that included a total of 67 breast cancer patients treated between 12/1/16 – 2/28/17. The patients diagnosed with HER2+ breast cancer records were retrospectively reviewed for adherence to quality measures pertaining to HER2 testing, SLNB, AD, and treatment. Follow-up reviews were completed 6 months after the launch of the online component, which included 142 patients.

Results:

Patient and disease characteristics were generally similar across the 2 cohorts. At baseline, treatment selection for patients with advanced stage cancer was consistent. The original goal of the activity was to assess adherence to quality measures in breast cancer treatment, in our assessment stage the team discovered potential undersampling of sentinel lymph nodes in patients who underwent neoadjuvant chemotherapy for clinically node-positive, with 3 of 8 patients (37.5%) having only 1 or 2 lymph nodes sampled. The educational programming improved recognition of the risk of false negative rates of sampling under 2 lymph nodes in this setting. In addition, the Inova team recommended that the triage protocol be changed to include the medical oncologist earlier in the treatment decision making process in tandem with the surgeon. In the post-program patient data, 26 patients with clinically N1/N2 disease had neoadjuvant therapy and a SLN biopsy. Of these, 3 (11.5%) had only 1 lymph node sampled, suggesting an increased adherence to recommended sampling.

The educational program also improved participant knowledge of the phase III APHINITY trial efficacy findings, which was consistent with an increase in the use of pertuzumab-containing adjuvant therapy for early breast cancer (use of TCHP, 0% vs 46% in the pre-program and post-program charts, respectively). In addition, participants in the educational programming increased awareness of the need for reflex testing in the event of an equivocal HER2 IHC result. In the post-program follow-up, no cases of equivocal HER2 IHC staining lacked reflex testing with FISH.

Taken together, these findings are consistent with practice change following interventional medical education for incorporating best practices and emerging clinical data in the management of HER2-positive breast cancer.

Citation Format: Harnden K, Hester D. Using continuing professional development (CPD) as an investigative tool to improve clinical practice and interdisciplinary team treatment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-08.