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CAR T-Cell Therapy: Oncology Nurses’ Educational Needs

Pre-activity assessment data from i3 Health's nursing continuing professional development (NCPD) activity "Understanding and Optimizing CAR T-Cell Therapy for Patients With B-Cell Malignancies" has revealed significant baseline knowledge gaps regarding the use of chimeric antigen receptor (CAR) T-cell therapy for the treatment of patients with B-cell malignancies.

Of the 584 learners who took the pretest and began the activity, 539 saw it through to completion. The learners who completed the activity were primarily registered nurses (92.9%), followed by nurse practitioners (4.6%), physicians (0.6%), a physician assistant (0.2%), a pharmacist (0.2%), and several individuals who selected "other" for their profession (1.5%).

On the activity pretest, only slightly over half of learners (53.6%) correctly identified that in CAR T-cell therapy, T cells are first drawn from a patient's blood, as opposed to their bone marrow (22.6%), hematopoietic stem cells (21.9%), or none of the above (1.9%). In CAR T-cell therapy, blood in the patient's arm flows through a tube to an apheresis machine, which removes the white blood cells, including the T cells, and sends the rest of the blood back to the patient. The gene for the CAR is inserted into the T cells, which are grown in the laboratory and then infused into the patient.

Only 43.2% of learners correctly identified the 40% chance of remission at six months for a patient with non-Hodgkin lymphoma treated with axicabtagene ciloleucel. However, over three-quarters of learners (75.2%) correctly identified that administration of levetiracetam on day 0 of CAR T-cell infusion could help to prevent this same patient from developing neurotoxicity.

Only 35.3% of learners recognized that the expected overall survival would be 19.1 months for a patient with relapsed B-cell acute lymphoblastic leukemia treated with tisagenlecleucel. Regarding the same patient seen three days after tisagenlecleucel infusion, 46.4% of learners recognized that while fever, capillary leak syndrome, and blood pressure of 72/41 mm/Hg would all be indicative of cytokine release syndrome, headaches would not be a symptom of cytokine release syndrome.

The post-activity assessment showed that significant learning took place during the activity with respect to these topics: 94.8% of learners recognized that the T cells used in CAR T-cell therapy are first drawn from a patient's blood, 91.5% recognized the six-month complete remission rate for axicabtagene ciloleucel in patients with non-Hodgkin lymphoma, 93.9% recognized that levetiracetam on day 0 of CAR T-cell infusion can help to prevent neurotoxicity, 86.7% recognized the median overall survival for patients with relapsed/refractory B-cell acute lymphoblastic leukemia treated with tisagenlecleucel, and 94.8% recognized that headaches are not a symptom of cytokine release syndrome.

Learners' performance on the post-activity assessment showed dramatic improvement over baseline knowledge levels, but awareness of these topics remained suboptimal, suggesting a continued area of educational need. i3 Health has determined that oncology nurses may benefit from future NCPD activities that provide education regarding the efficacy and safety of novel therapies for B-cell malignancies and the management of adverse events related to CAR T-cell therapy.

As a result of the activity, 91% of participants felt more confident in treating their patients with B-cell malignancies, and 91% felt that the material presented would be used to improve the outcomes of their patients. 


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