Abstract P1-15-05: Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclin-dependent kinase 4/6 inhibitors
Authors: Tolaney Sara , O'Shaughnessy Joyce A. , Crawford Rebecca , Ackbarali Tariqa , Greene Laurence , Carter Jeffrey , Sapir Tamar 
Published: March 2020

Abstract
Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) offer the potential to significantly improve outcomes for women with HR+, HER2- breast cancer. However, given the relative short time period of their availability, appropriate evidence-based uses of CDK4/6i therapies depend on effective education and implementation strategies. In the context of an accredited continuing medical education (CME) and quality improvement (QI) program, we conducted a survey study to identify educational needs and areas for improvement involving CDK4/6i decision-making and clinical management.
Methods: Baseline surveys were administered to medical oncologists and clinical staff in 2 large U.S. healthcare systems. The surveys included items for assessing participants’ challenges, barriers, and education/training needs in managing patients with HR+/HER2- breast cancer, specifically focusing on uses of CDK4/6i therapies. In addition to conducting the survey study, at baseline we audited 100 electronic medical records (EMRs) of women with HR+, HER2- breast cancer in each of the 2 systems. The oncology teams then participated in CME/QI activities in which national leaders in breast cancer research and education presented the baseline survey results and EMR-audit feedback, and guided participants in developing targeted action plans to overcome barriers and to close clinical gaps.
Results: Survey respondents were 15 medical oncologists, 3 nurses, and 2 QI personnel. Regarding their patients on CDK4/6i therapies, large percentages of the respondents indicated low levels of satisfaction with current CDK4/6i 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+/HER2- breast cancer were identifying women who would benefit from CDK4/6i therapies (35%), monitoring patients for disease progression (25%), and receiving support from administrative leadership (15%). Regarding facilitators to reducing patient risks of discontinuing CDK4/6i due to toxicity, the most common responses were increasing interprofessional collaboration and care coordination (45%), and providing education about adverse events to patients and caregivers (20%) and to oncology clinical team members (15%). Participants in the CME/QI activities developed action plans that included establishing protocols and EMR tracking mechanisms for monitoring patients using CDK4/6i therapies, tracking pharmacy dispensing of CDK4/6i therapies, and documenting patient characteristics such as staging, menopausal status, and progression to guide individualized treatment decision-making.
Conclusions: Concerning the implementation of CDK4/6i therapies, this survey study addresses challenges and variable practices that have been recently reported in the literature. The findings reveal specific education and training needs, along with targeted strategies, that are essential for promoting evidence-based, appropriate decision-making and management processes involving these therapies for women with HR+, HER2- breast cancer.
Citation Format: Sara Tolaney, Joyce A. O'Shaughnessy, Rebecca Crawford, Tariqa Ackbarali, Laurence Greene, Jeffrey Carter, Tamar Sapir. Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclin-dependent kinase 4/6 inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-15-05.