Assessing the Impact of Digital Education on the Clinical Management of Rare Hematologic Malignancies
Authors: Graham Tisheeka , Ackbarali Tariqa , Kowalski Katie , Castellino Sharon M. , Roth Lisa Giulino , Ehrhardt Matthew J. , Matasar Matthew 
Published: December 2024

BACKGROUND: Decision-making to achieve optimal treatment selection for patients with rare hematologic malignancies, including mantle cell lymphoma (MCL) and classical Hodgkin lymphoma (cHL), is a complex process. While progress is being made, many healthcare providers (HCPs) still experience challenges related to access to diagnostic tools, novel treatment approaches, and management of treatment-related adverse events. In collaboration with the National Organization for Rare Disorders (NORD), an educational series focused on rare hematologic disorders was designed to ensure that clinicians can appropriately apply current clinical evidenced-based approaches.

METHODS: As part of the Annual NORD Rare Hematology Series, two 60-minute activities in pediatric/adolescent and young adult (AYA) cHL were broadcasted live on Medlive.com in December 2022 and January 2024. The second cHL program included the patient voice in the form of a pre-recorded interview from which a short video vignette was selected to highlight during the CME activity. This vignetted reflected patient insights on the importance of collaboration during the decision-making process and highlight best practices for clinicians to improve their patient communication. A 30-minute CME activity in MCL was broadcasted on Medlive.com in December 2023. The programs will remain available on-demand for 1 year after the broadcast date. Knowledge and competence questions were administered pre-, immediate post-activity, and in post-program evaluations.

RESULTS: As of July 15, 2024, the educational programs were attended by 2,760 HCPs. Of these HCPs, 84% are clinicians, advanced practitioners (NP/PA), and nurses. CME questions administered across all programs revealed low baseline knowledge and competence across the following domains: efficacy/safety data, management of adverse events, survivorship and follow-up care plan, clinical presentation and diagnosis. Improvements in knowledge/competence were observed for pre/post paired responses across CME questions for both programs, with gains ranging from 20% to 30%. The top 3 challenges in managing pediatric/AYA patients with cHL were the ability for their patients to engage in normal activities (40%), managing side effects (31%), and anxiety about treatment efficacy (30%). These findings align with the insights provided by the patient during their interview. Notably, the patient shared that her quality of life (QoL) was negatively impacted by a chemotherapy-based regimen, which caused her to become immunocompromised. As a result she was unable to be vaccinated during the COVID-19 pandemic which worsened her QoL.

HCPs reported that secondary cancers (34%), infertility (32%), and heart disease (16%) are the most common late effects their pediatric/ AYA patients with cHL are most concerned. Although only 39% of HCPs reported that their institution provides long-term transition of care plans, 57% reported they are confident with transitioning patients with cHL from pediatric to adult care.

In the MCL program, the top HCP-reported challenges with diagnosis were limited knowledge about clinical presentation (27%), appropriate tests to order (25%), and differential diagnoses (22%). Post-activity, HCPs were surveyed to help gain insights into practice gaps and barriers to change. The top identified barriers to integrating Bruton tyrosine kinase inhibitors into clinical practice were lack of knowledge of evidence-based strategies (37%), lack of experience with targeted therapies (22%), and lack of familiarity of mechanisms of action (21%). HCPs indicated that the changes they intended to make post-activity were; apply the latest clinical guidelines, treatment approach, and current practice for referrals.

CONCLUSIONS: This online, interactive educational initiative led to greater awareness of evidence-based management strategies for MCL and pediatric/AYA cHL. These results indicate that digital educational initiatives can be effective tools for advancing clinical decision making. Future educational programs in rare hematologic malignancies are needed to help clinicians incorporate the latest clinical strategies to improve patient care.

The MCL program was supported by an independent educational grant from AstraZeneca Pharmaceuticals.

The cHL programs were supported by independent educational grants from Seagen and BMS.