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Martin Warters

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    P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.15-16 - Management of Patients with ALK-Translocated NSCLC: A Simulation-Based Assessment of Medical Oncologists’ Practice Decisions (ID 13989)

      12:00 - 13:30  |  Author(s): Martin Warters

      • Abstract


      The past several years have witnessed unparalleled changes in treatment for patients with ALK-translocated NSCLC. The objective of this study was to evaluate oncologists’ competence regarding the use of ALK tyrosine kinase inhibitors in the management of NSCLC and the impact of virtual patient simulation on narrowing gaps in clinical practices.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A CME certified virtual patient simulation (VPS) was made available via a website dedicated to continuous professional development. The VPS consisted of 2 cases presented in a platform that allows oncologists to assess the patients and make diagnostic and therapeutic decisions supported by an extensive database of diagnostic and treatment possibilities matching the scope and depth of actual practice. Clinical decisions were analyzed using a sophisticated decision engine, and instantaneous clinical guidance (CG) employing up-to-date evidence-base and faculty recommendations was provided after each decision. Oncologists were able to revise each decision post-CG, if desired. Rationales for clinical decisions were also collected in real time. Data were collected between 08/01/2017 and 10/31/2017.

      4c3880bb027f159e801041b1021e88e8 Result

      At the time of assessment, 178 oncologists had fulfilled the participation criteria for completing the simulation. Assessment of their practice choices revealed:

      · In a patient with newly diagnosed NSCLC, up to 30% of oncologists did not order testing for a tumor’s ALK translocation status. Moreover, only 37% ordered the appropriate therapeutic regimen. CG led to a 9% improvement in testing and 20% increase in evidence-based treatment (P<.001) Crizotinib remained the initial systemic treatment of choice despite data from the ALEX trial.

      · In a patient whose disease has progressed on crizotinib with significant disease burden, 24% of oncologists would not discontinue therapy. CG resulted in a 23% improvement in evidence-based treatment decisions (P=0.003). The primary rationales for the selected treatment differed based on the chosen regimen, disease control (26%) for continued treatment with crizotinib, better efficacy profile for the patient (24%) with use of ceritinib, andrecommended by guidelines (25%) for alectinib.

      · A majority of oncologists initially ordered side effect counseling in each case. CG resulted in a 18% (P=0.014) increase in the case for progression on crizotinib.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This study, using an immersive VPS, provided insights into oncologists’ real world practices, and the rationales behind them, in an evolving treatment landscape and uncovered a lack of clarity about identification of the most appropriate regimen for patients with ALK-translocated NSCLC. Our findings demonstrate a continued need to educate oncologists about how to select and prescribe treatment for these patients.