• Frontline treatment of follicular lymphoma (FL) yields high response rates, but most patients relapse. In addition, response rates and duration of response decline with subsequent treatments. These factors make management of this disease challenging.
• This study was conducted to assess current clinical practices of hematologist/oncologist specialists (Hem/Oncs) related to management of patients with FL in order to identify knowledge, competency, and practice gaps and barriers to optimal care.
• A continuing medical education (CME)-certified clinical practice assessment consisting of 25 multiple-choice knowledge- and case-based questions was developed to assess practice gaps.
• The questions were designed to measure knowledge, skills, attitudes, and competence of Hem/Oncs regarding risk stratification and evidence-based recommendations for optimal care of patients with FL.
• Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. The survey instrument was made available online to physicians without monetary compensation or charge.
• The survey launched on March 23, 2018, and these results are based on responses of 274 Hem/Oncs collected through July 18, 2018.
Results: The results are reported by grouping questions into specific themes in the management of patients with FL. The poster displays the percentage correct and incorrect responses for each question. A majority of the respondents practice in the community setting (52.8%), while 37.8% practice in an academic setting, and 9.3% classified their practice setting as 'other'.
• Knowledge of Prognostic Indicators and Risk Stratification Tools: On average, only 50% of Hem/Oncs demonstrated knowledge about prognostic factors, Follicular Lymphoma International Prognostic Index (FLIPI) 1 scoring, and genes included in the m-7 FLIPI. Less than half were aware of how FLIPI 2 differs from FLIPI 1, and only 18% knew the impact of EZH2 mutations on prognosis.
• Knowledge of Evidence-Based Guidelines: Over half of Hem/Oncs are aware of guideline-based recommendations for initial patient assessment and treatment of newly diagnosed and relapsed grade 2 FL.
• Knowledge of Trial Data: Hem/Oncs knowledge of trial data ranged widely from 12.8% to 66.3%. There was a trend toward less awareness of data presented at conferences and recently released data, indicating the challenge to stay up-to-date in a rapidly evolving field.
• Tailoring Treatment and Managing Adverse Events: Hem/Oncs demonstrated a strong ability to tailor therapy selections, including utilizing novel agents, such as second-generation phosphoinositide 3-kinase (PI3K) inhibitors. Hem/Oncs displayed above-average awareness of therapy-related adverse events (AEs) for first-generation PI3K inhibitors, but demonstrated less awareness of the AE profile of second-generation PI3K inhibitors - 75.4% identified diarrhea as the AE most likely to occur with idelalisib while only 45.5% identified hyperglycemia and hypertension as the AEs most likely to influence treatment selection with copanlisib.
• Confidence: As reported by Hem/Oncs regarding the treatment of patients is similar across the two confidence questions, with a slightly higher percentage being more confident treating newly diagnosed FL compared with relapsed/refractory FL. Less than 50% of Hem/Oncs are confident in their ability to risk-stratify patients with FL, which is suboptimal because risk. stratification should be included in the rationale for treatment selection.
• Barriers to Optimal Management of Patients With FL: Hem/Oncs indicated they are challenged to choose among available therapies and to select treatment for patients with relapsed/refractory FL.
• This research about clinical practices in management of FL identified
gaps in knowledge and competence of Hem/Oncs regarding:
-Identifying and managing adverse events of second-generation PI3K inhibitors
-Implementation of evidence-based guidelines and trial data into treatment decisions
-Tailoring therapy and selecting treatment for newly diagnosed and relapsed/refractory FL
• In order to provide optimal care to patients with follicular lymphoma, additional education focused on these areas is required for Hem/Oncs.