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Online Treatment Decision Tool Reveals Variances in Practice Among Experts and Oncology Health Care Providers

December 08, 2019

To effectively delay progression of follicular lymphoma (FL) while maintaining patient quality of life, it is critical that clinicians select therapy for patients with newly diagnosed FL that most optimizes clinical outcomes.

Rachael M Andrie, Clinical Care Options, LLC (Reston, VA), and colleagues from multiple institutions developed an online treatment decision support tool that provides case-specific, individual recommendations from multiple experts to help inform frontline treatment decisions among health care providers (HCPs) who care for patients with FL. In this presentation, team members showed data from an analysis of self-reported practice trends from HCPs using the tool compared with corresponding treatment recommendations from FL experts.

In May 2018, 5 experts in lymphoma patient care provided specific treatment recommendations for 72 distinct case scenarios of newly diagnosed FL defined by a simplified set of key patient and disease characteristics: disease stage, tumor grade, tumor bulk or burden, presence of symptoms, age and fitness, and patient’s primary goal for treatment.

Participating HCPs used selection menus to enter specific patient and disease factors along with their intended treatment plan for the case. After completing case entry, individual expert treatment recommendations for that specific patient case were displayed, followed by a short survey designed to determine the impact of the expert recommendations on the HCP’s planned course of treatment.

From August 2018 to July 2019, 311 HCPs (86% MDs) entered 522 patient case scenarios into the online tool. Among the 5 experts, there was a majority consensus in treatment selection for 89% of newly diagnosed FL cases. However, a comparison of expert and HCP treatment choices showed substantial variability for several different patient case scenarios. For example, more than 40% of HCPs recommended chemoimmunotherapy (CIT) for patients with grade 1-3a FL with low tumor burden and no symptoms in contrast to 100% of experts who recommended observation or single-agent rituximab. Among the HCPs whose intended treatment plan differed from the consensus expert recommendation, 60% indicated that they would change their initial choice of treatment after viewing the expert recommendations.

Presenters concluded that this case data suggests ongoing differences in practice between experts and HCPs for multiple case scenarios of newly diagnosed FL, including examples of potential overtreatment in patients with low tumor burden and undertreatment of patients with suspected transformation. Consensus expert recommendations in this online tool changed the intended treatment plan of many HCPs using it and, therefore, has the potential to optimize the care of patients newly diagnosed with FL.—Amanda Del Signore

2019 ASH Poster Abstract 414: Analysis of an Online Treatment Decision Tool Reveals Variances in Practice between Experts and Oncology Healthcare Providers for Newly Diagnosed Follicular Lymphoma

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