Session Information
Date: Sunday, November 5, 2017
Title: Education Poster
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Cancer immunotherapy targeting immune checkpoints represents a major advance in oncology, yet has been associated with immune-related adverse events (IRAEs) affecting many organ systems, including an expanding range of rheumatic manifestations. Rheumatologists are new to this field, and we sought to examine their awareness, experience, clinical confidence, and educational needs regarding IRAEs by surveying rheumatology practitioners.
Methods: In the 2nd quarter of 2016, questionnaires were sent via email to health care provider cohorts at Johns Hopkins University (JHU) and Cleveland Clinic (CC). The survey population came from their Continuing Medical Education (both) and Rheumatology Website (JH) databases. Both cohorts had physicians and advanced practitioners. Survey questions addressed domains of awareness, clinical experience, and interest in IRAE-specific medical education.
Results: Response rates were 114/2198 (5.2%) at CC and 39/789 (5.0%) at JHU. Male physicians from private practices and academic institutions predominated (table 1). Only 24.1% reported familiarity with IRAEs, with most unaware of IRAEs or lacking sufficient knowledge on the topic (table 2). Only 14.8% had seen a patient with an IRAE, with inflammatory arthritis the most common. Most (60.7%) did not feel confident managing IRAEs. All but one participant indicated interest in educational activities on IRAEs, with description/recognition of IRAEs perceived as the biggest educational need.
Conclusion: We conclude that most respondents 1) had limited experience with rheumatic IRAEs, 2) lacked confidence in clinically addressing IRAEs, and 3) had a strong expressed desire for targeted education. Although limited by response rate, responder bias, and the timing of the survey shortly after the approval of these drugs, the results suggest a considerable need for rheumatology-specific education around this topic.
|
Table 1. Demographic Variables (N = 153) |
|
|
Sex: N (%) |
Male: 93 (61%) Female: 60 (39%) |
|
Age: mean (SD) |
55.0 (12.4) |
|
Degree: N (%) |
MD/DO: 127 (83%) NP: 8 (5.2%) PA: 4 (2.6%) RN: 9 (5.9%) Other: 5 (3.3%) |
|
Years in medical practice: mean (SD) |
22.1 (12.9) |
|
Practice Setting: N (%) |
Academic: 43 (28.1%) Private Practice: 68 (44.4%) Hospital-based Practice: 25 (16.3%) Industry: 5 (3.3%) Other: 9 (5.9%) |
|
Table 2. ICI/IRAE provider experience |
|
|
Familiarity with ICIs (N= 133) |
I am unaware: 29 (21.8%) I have heard of them, but am not knowledgeable: 68 (51.1%) Familiar: 32 (24.1%) Very familiar: 2 (1.5%) Unsure: 2 (1.5%) |
|
Awareness of IRAEs (N= 130) |
I am unaware: 54 (41.5%) I have heard of them, but am not knowledgeable: 33 (25.4%) Familiar: 32 (24.6%) Very familiar: 8 (6.2%) Unsure: 3 (2.3%) |
|
Have seen a patient with an IRAE (N = 122) |
Yes: 18 (14.8%) No: 104 (85.2%) |
|
Types of IRAEs seen |
Inflammatory arthritis: 17 Sicca syndrome: 6 Myositis: 4 Vasculitis: 3 Colitis: 7 |
|
Confidence in management of IRAEs (N = 122) |
Not confident: 74 (60.7%) Somewhat confident: 30 (24.6%) Moderately confident: 14 (11.5%) Very confident: 4 (3.3%) |
To cite this abstract in AMA style:
Cappelli L, Calabrese C, Calabrese LH, Bingham III CO. Immunotherapy-Induced Rheumatic Disease: How Prepared Are Rheumatologists to Address This Emerging Condition? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/immunotherapy-induced-rheumatic-disease-how-prepared-are-rheumatologists-to-address-this-emerging-condition/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunotherapy-induced-rheumatic-disease-how-prepared-are-rheumatologists-to-address-this-emerging-condition/