New study works to improve physician adherence to CML treatment guidelines

Benjamin Brewer awarded NCCN grant to test novel behavior change and education intervention
Ben Brewer, PsyD

Ben Brewer, PsyD, director of clinical psychology services for the department of hematology and investigator at the University of Colorado Cancer Center

Bone marrow transplants or chemotherapy were once the only treatment options available for chronic myeloid leukemia (CML), a rare blood cancer. Until recently, survival rates weren’t remarkable; but new tyrosine kinase inhibitor medications, like imatinib, dasatinib and nilotinib, have transformed CML treatment—patients are now living full lives thanks to targeted therapy.

With new treatments come challenges. Because less than 6,000 Americans are diagnosed with CML each year, community oncologists have a hard time keeping up-to-date on treatment guidelines and adhering to the recommended monitoring schedule for the BCR-ABL1 gene marker, which measures a CML patient’s response to treatment. Without proper monitoring physicians don’t know if the medications are still working or if they’ve selected the right one for their patient.

“CML used to be one of the more difficult blood cancers to treat. Now, almost all patients respond to the new medications,” says Benjamin Brewer, PsyD, director of clinical psychology services for the department of hematology and investigator at the University of Colorado Cancer Center. “This has dramatically changed the treatment of this rare cancer. Oncologists aren’t used to worrying about whether their patients are adhering to their medication regimens. Now it needs to be top of mind.”

Recently the National Comprehensive Cancer Network (NCCN) Oncology Research Program, in collaboration with Pfizer Independent Grants for Learning & Change, awarded Brewer a two-year grant to assess the treatment of CML at four oncology practices across Colorado, including University of Colorado Hospital, St. Mary’s Hospital, Memorial Hospital and Poudre Valley Hospital.

The new study will test an intervention for oncology teams designed to address three concerns relevant to patients with CML and the doctors that treat them. The intervention is designed to improve monitoring of BCR-ABL1, improve the choices physicians make based on data from appropriate monitoring of this gene marker and teach physicians how to better address the problem of patient’s forgetting to take their medication for CML.

“I want to help physicians ask open-ended questions when they meet with their patients and have a true dialogue at every visit,” Brewer says. “If their patients are having difficulties taking their medications, I want to provide the physicians strategies to help their patients stay on schedule.”

Although vastly better than previous treatment approaches, tyrosine kinase inhibitor medications require lifelong monitoring and adherence. The NCCN guidelines currently recommend testing for BCR-ABL1 every three months after initiating therapy, regardless of treatment response. A recent report found that only 31 percent of community physicians and 52 percent of academic medicine physicians in the U.S. were correctly tracking this vital marker of treatment response in peripheral blood. Instead many are performing unnecessary bone marrow biopsies to conduct monitoring on a suboptimal timeline.

“The NCCN guidelines can be very complicated and if community physicians only see a few patients a year, it’s hard for them to keep up-to-date on the latest treatments and recommendations,” Brewer says. “They may know what medication to prescribe, but they may not know how patients need to be monitored for the long term and may not know when to switch medications if one stops working.”

Through interactive educational presentations, monitoring of BCR-ABL1 testing rates, and providing feedback about this rate to each practice, Brewer hopes to change physician and medical team behaviors at all four practices over two years and in turn, improve adherence to the NCCN guidelines for the treatment of CML.

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About the author: Kim Chriscaden

Kim Chriscaden is the former communications manager for the University of Colorado Cancer Center.

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