In 2004, the Centers for Disease Control and Prevention awarded funding (Coop. Agreement No. U58/CCU324301-01) for the Hematologic Oncology Primary Intervention Networking Group (HOPING), a national educational initiative of the Institute for Continuing Healthcare Education (the Institute). HOPING was developed to increase survivorship of patients with hematologic malignancies beyond 5 years. Its intent was to educate PCPs on the signs and symptoms of hematologic malignances to encourage more appropriate and timely referrals to a specialist, as well as to identify and bridge gaps in knowledge regarding the long-term follow-up and care of survivors of hematologic malignancies. Methods: Educational strategies included live presentations at primary care conferences, distribution of resource materials at an educational booth, and a resource Web site (www.hopingdocs.org). As part of the HOPING initiative, immediate participant feedback was gathered during live programs through an audience response system as well as through registrant surveys distributed at the booth and on the Web. The questions within those two settings were intended to gauge the practitioner’s ability to properly recognize the signs and symptoms of hematologic malignancies and provide appropriate follow-up care for patients with hematologic malignancies. Results: Data were collected from a total of 357 individuals (277 from live activities, 80 from online/booth surveys). Approximately 64% of the live program survey respondents were physicians; the majority identified themselves as family practice/family medicine or internal medicine specialists. When asked how they would monitor a 54-year-old male patient free from Hodgkin’s lymphoma for five years, only 44% of respondents correctly indicated that they would conduct an annual physical exam, clinical lab tests, thyroid function tests, and a chest x-ray. Respondents also showed lack of knowledge regarding appropriate studies to order for a patient presenting with specific symptoms and laboratory test results consistent with leukemia. The online/booth surveys were completed by 80 respondents; specific demographic data were not collected. Only 22% of respondents said that they are confident educating patients (and/or their caregivers) about hematologic malignancies. Respondents’ experience with available blood tests for MGUS and MDS was particularly poor -- only 10% said that they "have ordered" such tests while 46% were "unaware" of available tests. The overall ability of respondents to detect possible signs and symptoms of hematologic malignancies (specifically, leukemia, lymphoma, and multiple myeloma) was also low. Conclusion: In the eyes of the primary care community, hematologic malignancies are low-volume, high-risk conditions, and the complexity of diagnosing and providing long-term care to patients with hematologic malignancies is a growing challenge. Post-treatment chronic conditions such as late-onset cardiomyopathy, hypertension, and secondary malignancies often develop after therapy for hematologic malignancies and must be properly managed. Gaps in knowledge regarding the signs, symptoms, and diagnosis of hematologic malignancies may negatively impact timely referral to specialists. Because of their increasingly vital role in the cancer care continuum, PCPs need additional education to improve the short- and long-term outcomes of patients with hematologic malignancies.
Background:Immunotherapy was first introduced into the treatment of triple negative breast cancer with the approval of nab-paclitaxel + atezolizumab in patients with metastatic PD-L1-positive disease. Continued research sheds light on the utility of other immuontherapies in the metastatic setting as well as a potential role for immunotherapy in neoadjuvant disease. Given the factors impacting patient eligibility and the rationale for further exploring immunotherapy in novel settings, education can help ensure that oncologists are well-informed about available clinical trial data and ongoing research to optimize the use of immunotherapy in this subtype of breast cancer. The goal of this study was to determine if participation in an educational activity can improve the knowledge and competency of oncologists on the application of checkpoint inhibitors in the treatment of triple negative breast cancer.Methods: An online continuing education (CME) activity consisted of a 30-minute video discussion with synchronized slides between 2 panelists about the rationale and ongoing clinical trials exploring data for immunotherapy in triple negative breast cancer. Educational effect was assessed using a repeated pairs pre-assessment/post-assessment study design and compared of content-based pre- and post-assessment responses. A chi-square test was used to identify statistical differences between pre- and post-assessment responses. P values were calculated and those < 0.05 were considered statistically significant. Data from oncologist participants in the educational activity were collected between 3/22/20 through 5/19/20. Results:Participation in education resulted in statistically significant improvement and a considerable educational effect for oncologists (n=121; p <0.0001). 61% of oncologists reported practicing in a community setting with 67% treating patients beyond breast cancer alone. Overall, oncologists demonstrated a 20% increase in confidence in identifying the role and stage in triple negative breast cancer therapy for the use of immune checkpoint inhibitors. Improvements in knowledge were observed in: •Understanding the biological rationale for using immune checkpoint inhibitors in patients with triple negative breast cancer (69% vs. 83%; p <0.05) •Knowing the ongoing clinical trials that may impact the use of immune checkpoint inhibitors across the continuum of TNBC (69% vs. 87%; p <0.01) •Emerging clinical trial data on the use of immune checkpoint inhibitors utilizing pathologic complete response as an endpoint of efficacy in neoadjuvant disease (73% vs. 82%) Conclusions: This online, interactive, CME-certified educational activity resulted in significant overall gains in oncologist knowledge regarding the existing and emerging evidence for immunotherapy in triple negative breast cancer. These results demonstrate the effectiveness of on-demand education but also highlight the effectiveness in reaching community-based practitioners and also practitioners that do not specialize in breast cancer alone. Grantors: This educational initiative was supported through educational grants from Bristol Myers Squibb and Merck & Co., Inc. Citation Format: Kinjal Parikh, Charlotte Warren, Patrick Kugel, Ann Carothers, Haleh Kadkhoda, Leisha Emens. Utilizing education to strengthen oncologist' understanding of immunotherapy in triple negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-15.
Background: Hereditary Elliptocytosis (HEllip) is a congenital haemolytic anemia (HA) of predominantly dominant transmission, with heterogenous phenotype, caused by quantitative / qualitative alterations of erythrocyte membrane proteins. Most cases do not present anemia, only ellipticals in the peripheral blood smear (PBS);10 to 20% have HA of variable severity, and may present with splenomegaly. Hereditary pyro poikilocytosis (PPH) is a serious form of HEllip, the most severe phenotypes of which are associated with mutations in the self-association contacts of ab-spectrin. In the neonatal period, a transient poikilocytosis (PTN), with significant HA and marked anisopoikilocytosis, can be observed and be confounded with PPH. Clinical evolution allows the differentiation. PTN is associated with the predominance of HbF in this age group, with reduced affinity for the 2,3-DPG erythrocyte enzyme. From the first year of life, with the decline of HbF, the child will present a lighter phenotype typical of HEllip. Aims: Description of a clinical case of a rare form of congenital hemolytic anemia. Methods: Description in the form of a clinical case Results: Male infant, referred to the consultation at 7 months for microcytic / hypocromic anemia with poor response to iron oral suplementation. The research of his personal background revealed a hospitalizationin Neonatal Intensive Care Unit due to neonatal asphyxia and septic shock in second day of life. At this point he presented worsening of anemia (Hb) 9.2 g/dL, reticulocytosis and evidence of haemolysis, PBS with severe anisopoikilocytosis, fragmented RBC, with numerous elliptocytes and micro spherocytes. At this time he was medicated with oral iron, with a poor response in the Hb value. Due to the lack of response to the established oral iron, it was referenced to the consultationat 7 months. Hb studies (High performance liquid chromatography -HPLC) were normal and screening tests for hereditary spherocytosis were negative. Due to haemolytic conditions, with marked microcytosis, and the presence of marked anisopoikilocytosis in PBS, the most probable initial hypothesis was PPH. Sequencing of the STAPA1 gene excluded polymorphisms, such as a LELY . With about 18 monthsof age initiated spontaneous improvement of anemia and normalization of haemolysis parameters. In the last evaluation, he maintains excellent development, with Hb 11.3 g/dL, MCV 75.9fL, MCH 22.5pg, RDW 21 and reticulocytes 70G/L. Summary/Conclusion: The authors intend to alert to the difficulty to distinguish between these two entities, which, despite having a similar presentation in the neonatal period, have a different clinical course, emphasizing the importance of a careful follow-up during the first months/ year of life, avoiding parent's distress.
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