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Learning Needs: Checkpoint Inhibitors in Cervical Cancer

Assessment data: pretest versus posttest.

Pre-activity assessment data from i3 Health's continuing medical education (CME)/continuing nursing education (CNE) activity "Optimizing the Management of Advanced Cervical Cancer With Checkpoint Inhibitor Therapy" has revealed significant baseline knowledge gaps in the area of checkpoint inhibitor therapies for advanced cervical cancer.

Three hundred and ninety-seven learners took part in the educational activity and completed the pre-activity assessment, and 375 of these finished the activity and completed the post-activity assessment and evaluation. Participants included physicians, nurses, nurse practitioners, and other health care workers at all stages of their careers: 136 had been in practice for over 20 years, 73 had practiced for 16 to 20 years, 69 had practiced for 11 to 15 years, 60 had practiced for 6 to 10 years, and 86 had practiced for 0 to 5 years. Participants saw a mean of 7 patients with cervical cancer per month.

Prior to engaging in the educational content, participants were asked to complete a series of case-based questions to establish their baseline knowledge. Participation was anonymous, and correct answers were not revealed. Following completion of the activity, participants were asked the same questions in order to assess changes in their competence as a result of engaging in the educational activity.

On the pre-activity assessment, only 27.9% of participants were able to identify PD-L1 expression as a biomarker that could potentially guide treatment selection in a patient with advanced cervical cancer, and only 32.8% were able to identify the likelihood that a patient would experience a complete or partial response to treatment with chemotherapy combined with bevacizumab. Only 34.5% were able to identify the expected survival of a patient with PD-L1–positive recurrent cervical cancer that is treated with pembrolizumab, and only 30.5% were able to identify fatigue as the most common immune-related adverse event experienced by patients taking pembrolizumab. On the topic of patient counseling, 50.9% of participants recognized that pembrolizumab treatment should be withheld if a patient experienced a grade 3 immunotherapy-related maculopapular rash.

The post-activity assessment showed that significant learning took place during the activity with respect to these topics: 86.1% of participants correctly identified PD-L1 as a biomarker to guide treatment selection, 93.3% correctly recalled the objective response rate for bevacizumab, 93.1% remembered the median overall survival for pembrolizumab in PD-L1–positive recurrent cervical cancer, and 93.9% correctly identified fatigue as the most common immune-related adverse event associated with pembrolizumab. Knowledge of patient counseling also improved, with 94.9% of participants recalling the need to withhold pembrolizumab and administer prednisone for a grade 3 immunotherapy-related maculopapular rash.

While learners' performance on the posttest showed dramatic improvement over baseline knowledge levels, awareness of biomarkers to guide treatment selection improved but remained suboptimal, suggesting a continued area of educational need. i3 Health has determined that the multidisciplinary team may benefit from future CME/CNE activities that provide cervical cancer education regarding efficacy and safety of immunotherapies for metastatic disease, biomarkers for cervical cancer treatment selection, and patient counseling.

As a result of the activity, 93% of participants felt more confident in treating their patients with advanced cervical cancer, and 93% felt that the material presented would be used to improve the outcomes of their patients.


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