Analysis of Online Treatment Decision Tool Reveals Variation in FL Management Between Experts and Oncology HCPs

John Burke, MD, Rocky Mountain Cancer Center, Aurora, CO, discusses a study which assessed self-reported practice trends from health care professionals (HCPs) using an online treatment decision support tool and compared them with corresponding treatment recommendations from follicular lymphoma (FL) experts.

The tool was developed to help inform FL treatment decisions among HCPs, providing case-specific, individual recommendations from multiple experts in both the newly diagnosed and relapsed/refractory disease settings.

Transcript: Hello. I'm John Burke, from Rocky Mountain Cancer Centers in Aurora, Colorado. The first abstract I'm going to discuss is entitled "Variance in Practice Between Experts and Oncology Health Care Professionals for Follicular Lymphoma: Analysis of an Online Treatment Decision Tool."

There's an online educational company called Clinical Care Options that developed a tool to help hematologists, oncologists, advanced practice providers, etc—I'll call those health care professionals, HCPs—with their patients who have follicular lymphoma.

To construct this tool, Clinical Care Options got 5 American lymphoma experts together, and each of us gave our own therapy recommendations for many different scenarios in follicular lymphoma. For example, first‑line, high‑tumor‑burden, stage 4, in a fit patient, and we would give a recommendation for how we would treat that patient.

Another example would be second‑line, frail patient who had previously been treated with R‑CHOP. Another example would be third‑line, healthy patient who had been treated with benda‑obin followed by lenalidomide and rituximab. In each of those scenarios, we would go in and input what our treatment recommendation would be.

There were a total of 264 scenarios that each of us considered, incorporating factors like the stage, the patient's fitness, the tumor bulk, the EZH2 mutational status, and what line of therapy they were on.

The tool allows health care professionals to go online, input their patient's information and their own health care professional's treatment plan, and then the expert recommendations would be shown to the HCP. That HCP was then asked whether the expert recommendations were the same as or different from their plan, and whether their recommendations impacted their treatment plan.

Keep in mind that not all 5 expert recommendations were always the same. For example, one expert might favor use of bendamustine plus rituximab in the front‑line, whereas a different expert might recommend, say, CHOP plus obinutuzumab or something. There could be differences among the experts.

Between March and November of 2021, 353 cases were entered into the tool by 235 health care professionals from all over the world. Some were using the tool for hypothetical cases, presumably to learn about the disease, but the majority were using the tool for specific patients who were in their practice.

The results of this study, we looked at the outcomes, and 35% of the time, the expert recommendations changed the health care professional's treatment recommendations, and 41% of the time, the expert recommendations confirmed the health professional's intended treatment plan.

There were some differences between the groups. In low‑tumor‑burden, front‑line therapy, the experts universally recommended watchful waiting, or as the health care professionals commonly recommended, chemoimmunotherapy.

In high‑tumor‑burden, front‑line therapy for advanced‑stage, the experts were more likely to choose bendamustine as their chemotherapy agent, whereas the health care professionals were more likely to choose CHOP or CVP chemotherapy.

In the second line, the experts were more likely to recommend lenalidomide and rituximab, whereas the health care professionals were more likely to recommend chemoimmunotherapy. One can question whether that's due to geographic differences, availability of lenalidomide, familiarity with the regimen, etc. We don't really know.

In the third‑line, the experts were more likely to recommend tazemetostat or chemoimmunotherapy, whereas health care professionals were more likely to recommend a PI3 kinase inhibitor or to be uncertain about what to use.

One limitation is that the tool was developed before the approval of CAR T‑cell therapy. That was not incorporated into the tool at this point.

The conclusion of the study is that the tool may be helpful for practitioners to easily get guidance from experts on the management of their patients with follicular lymphoma, that there were some significant differences between what experts were recommending and what health care professionals had intended to do.

About a third of the time, the treatment recommendation from the health care professional would change based on review of these expert recommendations using the tool.

The tool is available online through Clinical Care Options.