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Impact of an Educational Seminar Series for VA Providers in Personalized Cancer Care Across Hematologic and Solid Tumors
Purpose/Rationale: To address educational needs of hematology/oncology providers in VA and other federal settings, we conducted a national series of accredited 6-hour seminars. Through surveys, we assessed baseline barriers and educational outcomes.
Background: Recent landmark advances in cancer therapies engender pressing needs for education among VA providers.
Methods: The educational seminars were held in 9 US cities with large VA facilities between November 2017 and March 2018. The agenda, covering hematologic malignancies (3 hours) and solid tumors (3 hours), emphasized evidenced-based and guideline-directed uses of new cancer therapies. Before and after the seminars, participants completed surveys designed to assess self-reported barriers, confidence, and competence regarding personalized medicine approaches to implementing the therapies.
Results: Survey respondents (n = 639) were physicians (29%), pharmacists (23%), nurses (21%), physician assistants (18%), and nurse practitioners (9%) who practice in VA clinics and other federal settings; providers reported seeing an average of 103 oncology patients per month. On the pre-seminar survey, gaps were indicated by relatively small proportions of respondents who reported that their decision-making involving new cancer therapies is guided by genetic/prognostic testing (21%) and assessing patientspecific characteristics including comorbidities (38%); 42% reported having inadequate staff training for personalized hematology/oncology care.
Across the pre- to post-seminar surveys, there were significant increases (P < .0001 for all comparisons) in the proportions of respondents who reported: (1) high confidence in using immunotherapies (17% to 38%), targeted therapies (19% to 37%), and hormonal therapies (20% to 36%); and (2) high competence in performing various clinical skills, including identifying genetic tests for patients with acute myeloid leukemia (8% to 42%), interpreting genetic tests to support personalized treatment decision-making for patients with chronic lymphocytic leukemia (7% to 42%), recognizing and managing adverse events associated with targeted therapies (15% to 48%), and applying precision medicine principles in managing patients with highgrade gliomas (17% to 44%).
Conclusions/Implications: These findings indicate the positive impact of intensive education on self-reported confidence and competence among VA providers in applying personalized medicine approaches to implementing new cancer therapies. We will present additional baseline barriers and educational outcomes, as well as the seminar participants’ gap-targeted action plans for improvement.
Purpose/Rationale: To address educational needs of hematology/oncology providers in VA and other federal settings, we conducted a national series of accredited 6-hour seminars. Through surveys, we assessed baseline barriers and educational outcomes.
Background: Recent landmark advances in cancer therapies engender pressing needs for education among VA providers.
Methods: The educational seminars were held in 9 US cities with large VA facilities between November 2017 and March 2018. The agenda, covering hematologic malignancies (3 hours) and solid tumors (3 hours), emphasized evidenced-based and guideline-directed uses of new cancer therapies. Before and after the seminars, participants completed surveys designed to assess self-reported barriers, confidence, and competence regarding personalized medicine approaches to implementing the therapies.
Results: Survey respondents (n = 639) were physicians (29%), pharmacists (23%), nurses (21%), physician assistants (18%), and nurse practitioners (9%) who practice in VA clinics and other federal settings; providers reported seeing an average of 103 oncology patients per month. On the pre-seminar survey, gaps were indicated by relatively small proportions of respondents who reported that their decision-making involving new cancer therapies is guided by genetic/prognostic testing (21%) and assessing patientspecific characteristics including comorbidities (38%); 42% reported having inadequate staff training for personalized hematology/oncology care.
Across the pre- to post-seminar surveys, there were significant increases (P < .0001 for all comparisons) in the proportions of respondents who reported: (1) high confidence in using immunotherapies (17% to 38%), targeted therapies (19% to 37%), and hormonal therapies (20% to 36%); and (2) high competence in performing various clinical skills, including identifying genetic tests for patients with acute myeloid leukemia (8% to 42%), interpreting genetic tests to support personalized treatment decision-making for patients with chronic lymphocytic leukemia (7% to 42%), recognizing and managing adverse events associated with targeted therapies (15% to 48%), and applying precision medicine principles in managing patients with highgrade gliomas (17% to 44%).
Conclusions/Implications: These findings indicate the positive impact of intensive education on self-reported confidence and competence among VA providers in applying personalized medicine approaches to implementing new cancer therapies. We will present additional baseline barriers and educational outcomes, as well as the seminar participants’ gap-targeted action plans for improvement.
Purpose/Rationale: To address educational needs of hematology/oncology providers in VA and other federal settings, we conducted a national series of accredited 6-hour seminars. Through surveys, we assessed baseline barriers and educational outcomes.
Background: Recent landmark advances in cancer therapies engender pressing needs for education among VA providers.
Methods: The educational seminars were held in 9 US cities with large VA facilities between November 2017 and March 2018. The agenda, covering hematologic malignancies (3 hours) and solid tumors (3 hours), emphasized evidenced-based and guideline-directed uses of new cancer therapies. Before and after the seminars, participants completed surveys designed to assess self-reported barriers, confidence, and competence regarding personalized medicine approaches to implementing the therapies.
Results: Survey respondents (n = 639) were physicians (29%), pharmacists (23%), nurses (21%), physician assistants (18%), and nurse practitioners (9%) who practice in VA clinics and other federal settings; providers reported seeing an average of 103 oncology patients per month. On the pre-seminar survey, gaps were indicated by relatively small proportions of respondents who reported that their decision-making involving new cancer therapies is guided by genetic/prognostic testing (21%) and assessing patientspecific characteristics including comorbidities (38%); 42% reported having inadequate staff training for personalized hematology/oncology care.
Across the pre- to post-seminar surveys, there were significant increases (P < .0001 for all comparisons) in the proportions of respondents who reported: (1) high confidence in using immunotherapies (17% to 38%), targeted therapies (19% to 37%), and hormonal therapies (20% to 36%); and (2) high competence in performing various clinical skills, including identifying genetic tests for patients with acute myeloid leukemia (8% to 42%), interpreting genetic tests to support personalized treatment decision-making for patients with chronic lymphocytic leukemia (7% to 42%), recognizing and managing adverse events associated with targeted therapies (15% to 48%), and applying precision medicine principles in managing patients with highgrade gliomas (17% to 44%).
Conclusions/Implications: These findings indicate the positive impact of intensive education on self-reported confidence and competence among VA providers in applying personalized medicine approaches to implementing new cancer therapies. We will present additional baseline barriers and educational outcomes, as well as the seminar participants’ gap-targeted action plans for improvement.
Double-Expressor Lymphoma (DEL) in Veterans at DC VAMC
Purpose: To identify DEL amongst veteran patients with diffuse large B cell lymphoma (DLBCL) and its outcome.
Background: Molecular profile determines prognosis in DLBCL. Activated B-cell (ABC), a subtype of DLBCL, is associated with poor outcome compared to germinal center Bcell (GCB). Poor response to standard chemotherapy is seen with double-hit lymphomas as detected by FISH (5% -10% of DLBCL) and DELs that express both MYC and BCL-2 as detected by immunohistochemistry (IHC) (cutoffs—30% MYC, 40% BCL-2), with a median overall survival of <12 months.
Methods: Sixty-nine DLBCL patients diagnosed at DC VAMC from 1/1996-4/2016 were identified utilizing cancer registry. IHC stains were reviewed for CD3, CD10, CD20, BCL-2, BCL-6, C-MYC, MUM-1, MIB1, and p53. DLBCL were sub-classified as GCB and ABC based on CD10, BCL6 and MUM1 stains. Demographic data, diagnosis, treatment and outcome in terms of relapse and death are analyzed and will be presented at the meeting.
Results: Of the 69 DLBCL cases, only 37 met inclusion criteria; 32 were excluded due to unavailable blocks (20, mostly sent to outside institutions), tissue exhaustion with incomplete IHC data (6), T-cell rich B cell lymphoma (5) and pending (1). 20 cases are GCB and 17 ABC. All cases are CD20 positive with high mib1. MYC is positive in 17 cases (46%) and 15 of them double positive for BCL-2 (40%).
Implications/Future Directions: DLBCL veterans at the DC VAMC have a high percentage of double expressors when compared to the literature. It will be important to examine clinical data, treatment, and outcome to develop better treatment guidelines for double-expressor DLBCL. Future studies are in plan to compare double hit lymphomas to double expressors.
Purpose: To identify DEL amongst veteran patients with diffuse large B cell lymphoma (DLBCL) and its outcome.
Background: Molecular profile determines prognosis in DLBCL. Activated B-cell (ABC), a subtype of DLBCL, is associated with poor outcome compared to germinal center Bcell (GCB). Poor response to standard chemotherapy is seen with double-hit lymphomas as detected by FISH (5% -10% of DLBCL) and DELs that express both MYC and BCL-2 as detected by immunohistochemistry (IHC) (cutoffs—30% MYC, 40% BCL-2), with a median overall survival of <12 months.
Methods: Sixty-nine DLBCL patients diagnosed at DC VAMC from 1/1996-4/2016 were identified utilizing cancer registry. IHC stains were reviewed for CD3, CD10, CD20, BCL-2, BCL-6, C-MYC, MUM-1, MIB1, and p53. DLBCL were sub-classified as GCB and ABC based on CD10, BCL6 and MUM1 stains. Demographic data, diagnosis, treatment and outcome in terms of relapse and death are analyzed and will be presented at the meeting.
Results: Of the 69 DLBCL cases, only 37 met inclusion criteria; 32 were excluded due to unavailable blocks (20, mostly sent to outside institutions), tissue exhaustion with incomplete IHC data (6), T-cell rich B cell lymphoma (5) and pending (1). 20 cases are GCB and 17 ABC. All cases are CD20 positive with high mib1. MYC is positive in 17 cases (46%) and 15 of them double positive for BCL-2 (40%).
Implications/Future Directions: DLBCL veterans at the DC VAMC have a high percentage of double expressors when compared to the literature. It will be important to examine clinical data, treatment, and outcome to develop better treatment guidelines for double-expressor DLBCL. Future studies are in plan to compare double hit lymphomas to double expressors.
Purpose: To identify DEL amongst veteran patients with diffuse large B cell lymphoma (DLBCL) and its outcome.
Background: Molecular profile determines prognosis in DLBCL. Activated B-cell (ABC), a subtype of DLBCL, is associated with poor outcome compared to germinal center Bcell (GCB). Poor response to standard chemotherapy is seen with double-hit lymphomas as detected by FISH (5% -10% of DLBCL) and DELs that express both MYC and BCL-2 as detected by immunohistochemistry (IHC) (cutoffs—30% MYC, 40% BCL-2), with a median overall survival of <12 months.
Methods: Sixty-nine DLBCL patients diagnosed at DC VAMC from 1/1996-4/2016 were identified utilizing cancer registry. IHC stains were reviewed for CD3, CD10, CD20, BCL-2, BCL-6, C-MYC, MUM-1, MIB1, and p53. DLBCL were sub-classified as GCB and ABC based on CD10, BCL6 and MUM1 stains. Demographic data, diagnosis, treatment and outcome in terms of relapse and death are analyzed and will be presented at the meeting.
Results: Of the 69 DLBCL cases, only 37 met inclusion criteria; 32 were excluded due to unavailable blocks (20, mostly sent to outside institutions), tissue exhaustion with incomplete IHC data (6), T-cell rich B cell lymphoma (5) and pending (1). 20 cases are GCB and 17 ABC. All cases are CD20 positive with high mib1. MYC is positive in 17 cases (46%) and 15 of them double positive for BCL-2 (40%).
Implications/Future Directions: DLBCL veterans at the DC VAMC have a high percentage of double expressors when compared to the literature. It will be important to examine clinical data, treatment, and outcome to develop better treatment guidelines for double-expressor DLBCL. Future studies are in plan to compare double hit lymphomas to double expressors.
