Iron Overload Diagnosis and Management Among Clinicians: International Survey Showing Gaps In Knowledge and Need for Continuing Educational Programs

Clinical competence and practice performance among clinicians are difficult to measure. Self-assessments, while subjective, may determine gaps in knowledge and competence that affect performance. To determine the current knowledge level, competence, and clinical practices in diagnosing and managing iron overload (IO), an international survey was conducted among clinicians participating in the European School of Haematology (ESH) Iron Metabolism & Related Disorders Curriculum on the ESH website.

An online survey was sent to 1197 participants in the ESH Curriculum to self-assess their level of competence and clinical practices in IO and its treatment in patients with myelodysplastic syndromes, thalassemia, sickle cell disease, hereditary hemochromatosis, and rare anemias.

Seventy-three of the 1197 participants responded to the survey, showing interest in the topic. Sixty-three (86.3%) were physicians, the majority of whom were hematologists (49.3%) or pediatric oncologists/pediatric hematologic oncologists (21.9%). Although 66.7% stated they always screen patients at risk for IO, only 50% said they always institute early iron chelation therapy (ICT) in patients with IO. While 73.4% of respondents stated they always instruct patients on the importance of adherence to ICT, only 58.5% always monitor their patients for adherence. Similarly, 60.9% of respondents stated that they always monitor patients for change in status and treatment response to ensure optimal dosing, but only 37.3% consider titration of ICT to reduce or maintain iron levels.

Respondents were especially interested in further information on methods for monitoring iron load (77.6%), clinical guidelines for treatment of IO (74.6%), effect of IO on cardiac function/toxicity (67.2%), early identification of patients at risk for IO (65.7%), efficacy/safety of oral ICT (61.2%), and safety issues as they relate to IO treatment (61.2%).

By self-assessment, 64.4% of the survey responders rated their current level of competence as high/very high regarding their ability to diagnose IO, evaluate techniques for assessing tissue iron levels, and interpret the findings; 70.2% also rated their ability to assess which patients were at risk of IO, the organs affected by IO, and the clinical sequelae/disease burden of IO as high/very high. Although 70.3% rated their ability to describe the rationale for using ICT and the mechanisms of action of various ICTs as high/very high, only 62.5% felt an equivalent ability to differentiate across various ICTs regarding their efficacy/safety, frequency/methods of administration, and approved indications for specific patient populations. More than 80% rated their desired level of competence as high/very high in terms of the ability to diagnose IO, assess tissue IO, and interpret the findings (84.0%); the ability to assess patients at risk for IO (89.4%); the rationale for using ICTs and the mechanisms of action of various ICTs (87.3%); and, most important, the ability to differentiate across ICTs regarding efficacy and safety, administration, and approved indications in specific populations (93.5%). The gaps between current level of competence and desired level of competence signal a need for continuous education on this topic.

The survey points out significant gaps between clinicians' self-assessed levels of knowledge and competence in diagnosing and managing IO and implementation of this knowledge into practice. This was particularly evident in the gap between clinicians' desired level of competence in differentiating between various ICTs and their current level of competence in this area. The gaps uncovered in this survey highlight the fact that continuous educational reinforcement is critical for information to be incorporated into practice. The response rate to the survey among clinicians currently participating in an iron metabolism curriculum demonstrates their strong interest in these programs and their desire for continuing education in the areas identified.

Cappellini:Novartis Pharmaceuticals Corporation: Consultancy, Speakers Bureau. Beris:Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Vifor International: Consultancy. Brissot:Novartis Pharmaceuticals Corporation: Research Funding, Speakers Bureau. Porter:Novartis Pharmaceuticals Corporation: Consultancy, Research Funding, Speakers Bureau; Genzyme Corporation: Consultancy; Resonance Health Ltd: Consultancy. Taher:Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.