Gaps Apparent in Physicians’ Knowledge of CLL, MCL

A survey found knowledge gaps in the treatment of refractory/relapsed chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) in physicians in Germany, France, and the US, according to research published in BMC Cancer.¹

Treat and management strategies changed for individuals with CLL after new effective oral targeted therapies such as Bruton tyrosine kinase inhibitors (BTKi) were introduced.² However, due to the complexity of these treatment strategies, physicians may not be well versed about appropriate diagnostic methods and plans of treatment.

Due to the complexity of treatment strategies for CLL and MCL, physicians may not be well versed about appropriate diagnostic methods and plans of treatment.| Image Credit: © bnenin - stock.adobe.com

For the study, physicians were asked to fill out a survey that had 3 sections that inquired about CLL only, MCL only, and CLL and MCL together.¹ The first 2 sections included self-report questions that assessed the physicians' knowledge and skill levels and the frequency of treatment practices related to CLL and MCL. The last section included questions on self-confidence in selecting treatment options and the frequency of specific practices and agreements.

The survey found 5 key areas of educational needs among hemato-oncologists and hematologists:

• Knowledge of treatment guidelines
• Knowledge of molecular testing to aid treatment guidelines
• Skills in using patient profiles such as comorbidities and molecular testing as a part of treatment plans
• Balancing the risk of toxicity with the benefits of treatment
• Patient-provider communication and shared decision-making

Knowledge of Treatment Guidelines

Most of the physicians in France were knowledgeable about the national guidelines on CLL and MCL but had knowledge gaps in other guidelines, such as guidelines by the European Society for Medical Oncology (ESMO) and European Hematology Association (EHA). Physicians in the German academic settings were more knowledgeable in national as well as international and European guidelines. A similar trend was seen in the US, except in one instance where
physicians from the community setting had more knowledge of International Workshop on Chronic Lymphocytic Leukemia guidelines.

When asked about their next steps in an older patient with CLL progression who was started on ibrutinib 4 years ago, 79% stated that they would perform molecular or cytogenetic testing whereas 21% said they would start treatment. More physicians from both Germany and the US in community settings stated that they would start treatment than their academic counterparts.

When asked specifically about their next treatment plans, 48% did not adhere to guideline recommendations and instead opted for other options such as switching to chemoimmunotherapy.

Molecular Testing to Aid in Treatment Plans

When asked about the most important molecular tests to plan treatment for patients with refractory/relapsed CLL, the majority of physicians selected del17p followed by TP53. The test for PLCG2 was selected by a very low percentage of physicians as important. A similar pattern was seen in tests important for the diagnosis of refractory/relapsed MCL.

The majority of the physicians (66%) had suboptimal knowledge of the impact of molecular testing of PLCG2, while only 30% had suboptimal knowledge about testing for del17p. The study also noted that when a test was perceived as less relevant in deciding treatment, the physician had lesser knowledge about it.

Making Treatment Decisions According to Patient Profile

With regards to CLL, 27% of physicians reported suboptimal knowledge in deciding which patients needed a molecular or genetic test, with the majority of them being from the US. Nearly a third of them (32%) reported suboptimal levels in making treatment decisions based on these tests. Thirty percent had knowledge gaps in treating patients with multiple comorbidities, with more physicians in the community setting in both Germany and US reporting such gaps.

A relatively higher percentage of physicians with suboptimal knowledge was reported while dealing with patients with MCL. Thirty-four percent reported knowledge gaps in assessing which patients needed a molecular or genetic test and 37% had gaps in making treatment choices based on these tests.

Balancing the Risk of Toxicity With the Benefits of Treatment

With regards to CLL, more than one-third (34%) of physicians showed skill gaps in weighing the risks and benefits of using BTKi according to the patient profile. This gap was more pronounced in physicians with lesser experience. Forty-two percent of the respondents agreed or strongly agreed that certain BTKi had a reduced risk for cardiac toxicity while another 42% slightly agreed with the same statement.

Less than a third (26%) of physicians reported low confidence in selecting treatment for patients with relapsed/refractory MCL considering the side effects and toxicities. Thirty-five percent of physicians agreed or strongly agreed that certain BKI inhibitors had a reduced risk for cardiac toxicity while 41% slightly agreed with that statement.

This study found significant knowledge gaps among health care workers and proposed continuing medical education for physicians, especially those in community settings and younger physicians.

References
1. Peloquin S, Cymbalista F, Dreyling M, et al. Knowledge, skills, and confidence gaps impacting treatment decision making in relapsed/refractory chronic lymphocytic leukemia and mantle cell lymphoma: a quantitative survey study in France, Germany, and the United States. BMC Cancer. 2024;24(1):1003. doi:10.1186/s12885-024-12745-1
2. Hampel PJ, Parikh SA. Chronic lymphocytic leukemia treatment algorithm 2022. Blood Cancer J. 2022;12(11):161. doi:10.1038/s41408-022-00756-9