Physician Competence in Common Terminology Criteria for Adverse Events (CTCAE) Grading of Peripheral Neuropathy in Multiple Myeloma

Abstract 4702

Treatment-induced peripheral neuropathy (PN) remains a clinical challenge in the management of patients with multiple myeloma (MM). A number of strategies have been developed to prevent the condition including modifications to dose, schedule, or mode of administration of PN-causing agents or selection of alternative active agents with reduced PN risk. Given the increasing number of options to reduce or mitigate PN, recognition of symptoms and appropriate grading is important to manage the toxicity and prevent cumulative or irreversible PN. An independent certified education series focusing on proteasome inhibition in MM, including associated toxicities and management, was conducted at hospitals, medical centers, cancer centers, medical practices, and community dinner venues throughout the United States. From April 2011 to January 2012, 51 live 1-hour education activities presented by respected leaders in the MM field were implemented in accordance with the essential areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) and Accreditation Council for Pharmacy Education (ACPE). The target audience for this program was hematologists, hematologist-oncologists, medical oncologists, oncology specialty pharmacists, and allied healthcare professionals charged with the care of patients with MM. The program educated 999 healthcare professionals including 553 physicians. Of the 553 physicians, 309 (56%) listed specialties that fell within the target audience. Practitioner knowledge, competence, and confidence were assessed via case vignettes prior to and immediately following each educational activity using an audience response system. Case vignette surveys completed 6 weeks following each activity evaluated practitioner performance. Practice gaps were identified through comparison of current best practices versus actual participant responses. Competence in CTCAE grading was assessed with a case vignette containing PN symptoms. Participants were asked to select the grade of PN from multiple choice answers of grades 1 through 5. Participation by the target physician audience in the assessment included 177 prior to the education, 176 after the education, and 54 at 6-weeks following the activity. The baseline grading gap for the physician target audience was 45%. Immediately following the education, there was a 30% improvement yielding a remaining practice gap of only 15%. However, educational erosion for PN CTCAE grading at 6 weeks was 24%, yielding only a 6% improvement over baseline and suggesting the majority of practitioners did not retain PN grading competency. Baseline, knowledge and competence gaps for all other assessments ranged from 32% to 68% and were reduced immediately following the education and at 6 weeks following the activity. While some educational erosion did take place at 6-weeks in other areas, it only ranged from 9% to 10% compared to 24% erosion for PN grading. Overall, physician knowledge, competence, and confidence were improved by this educational series. However, for CTCAE grading of PN, there was increased educational erosion suggesting a need for serial education to reinforce physician awareness of current grading criteria.