Optimizing the use of EGFR antibodies across the continuum of care in mCRC: Effect of online education on clinician knowledge, competence and confidence
Authors: G. Fisher, W. Guerra, C. Day, C. Montagut
Journal: Annals of Oncology (2018)

Introduction: Optimal application of EGFR antibodies across the continuum of care in metastatic colorectal cancer (mCRC) is critical to achieve the best patient outcomes. A good understanding of the implications of current evidence on treatment beyond progression and re-challenge is important in informing clinical decision making. This study determined whether online continuing medical education (CME) could increase- knowledge and competence related to applying best practices for RAS screening and monitoring, and selecting the right treatment approach for the individual patient across the continuum of care. Methods: A 30-minute online video roundtable discussion between 3 experts was launched for countries outside the United States in March 2017, with data collected until June 2017. Educational effect was assessed with a repeated-pairs pre-/post-assessment study design, in which each individual participant served as his/her own control. 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale (confidence) question were analyzed. Chi-squared test assessed pre- to post-assessment change (5% significance level, P <.05). Magnitude of change in total number of correct responses overall, and for each question, were determined with Cramer's V (effect size: <0.05 none/minimal; 0.06-0.15 small, 0.16-0.30 medium, >0.30 large). Results: 141 oncologists completed both pre- and post-assessments. Baseline understanding was modest with 39-64% of participants identifying the correct answer for each question. Overall, a medium education effect was observed (V = 0.212, p < 0.001). The number of participants answering 3/3 questions correctly increased from 16% to 41% from pre- to post-assessment. Specific improvements included: identification of the advantage of liquid biopsy for assessment of RAS status to inform 2nd and further line treatments (95% improvement, P <.001; V = 0.373), identification of the need for RAS and other mutation testing post-progression on 1st line EGFR inhibitor combined with chemotherapy to inform treatment decisions (17% improvement, P = 0.038; V = 0.123), identification of the potential to use cetuximab combined with irinotecan as a treatment option in a patient that had previously progressed on cetuximab + chemotherapy then bevacizumab + chemotherapy in the 1st and 2nd lines, with a confirmed RAS WT tumour (25% improvement, P = 0.022, V = 0.137). 27% of participants reported increased confidence in using RAS mutational testing to inform treatment decisions for mCRC that is progressing. Conclusion: This on-demand, online video roundtable discussion resulted in a positive education effect and increased confidence amongst the participants. However, the data indicate that there remains a persistent educational need with less than half of participants answering all 3 questions correctly post-assessment. Online medical education is valuable in supporting the application of best practice, as well as identifying areas of continued educational need.