Abstract
Introduction
Patients with hematologic malignancies are living longer than ever before, thanks, in part, due to advances in diagnostic tools, the development of novel therapies, and enhanced supportive care. As survival improves, a broader range of healthcare providers will be involved in managing these patients' complex needs. While their definitive management relies upon specialists, many patients diagnosed with cancer depend upon various caregivers to manage disease-related complications in acute care settings. However, evidence suggests that clinicians without specialized training in hematology and/or oncology often feel underprepared to care for this vulnerable population. This pilot curriculum aims to equip these health care providers with a practical, high-yield framework for approaching commonly encountered complications in the management of patients diagnosed with hematologic malignancies. This work has the potential to enhance medical knowledge, improve patient outcomes, and promote clinical safety.
Methods
This curriculum was initially piloted with two learner groups: second-year internal medicine residents enrolled in their residency program's Hospital Medicine Track (HMT) and incoming first-year Hematology/Oncology fellows. Participants first completed a survey assessing their comfort level in managing various complications associated with hematologic cancers. They received concise, one-page educational summaries on these high-yield topics which were selected by a multidisciplinary team and developed with expert input and review. The program also included an in-person case-based discussion that was led by at least one senior hematology/oncology fellow and an attending physician. The cases are designed to reinforce the key concepts outlined in the review sheets and allow for robust discussion around clinical management and challenges. During the session, participants were probed to develop differential diagnoses and management plans based upon the hypothetical clinical scenario. Finally, participants completed an anonymous post-session survey.
Results
A total of 14 physicians participated in this pilot study. Six of these were internal medicine residents in the HMT (n=6/14, 43%) and eight were incoming first-year hematology/oncology fellows during their orientation held prior to the start of their clinical rotations. Post-session survey response rates were 83% (n=5) for the resident cohort and 75% (n=6) for the fellow cohort.
The intervention (documents and case-based discussion) led to an increase in comfort in caring for complications in patients diagnosed with hematological malignancies. Prior to the session, the average comfort level (on a 1–5 scale) for managing cytokine release syndrome (CRS) was 2.14, which increased to 3.90 post-session. Comfort with immune effector cell-associated neurotoxicity syndrome (ICANS) and graft-versus-host disease (GVHD improved from 2.07 to 3.63 and from 2.14 to 3.45, respectively. For neutropenic fever, participants already reported a relatively high baseline comfort level of 3.70, which increased further to 4.36. Comfort in managing transfusion reactions increased from 2.92 to 4.00. For complications related to acute leukemia (disseminated intravascular coagulation, tumor lysis syndrome, hyperleukocytosis, and differentiation syndrome), average comfort improved from 2.28 to 3.90. Lastly, comfort with engraftment syndrome management rose from a low baseline of 1.71 to 3.27 following the session. When asked about the usefulness of the review documents and case-based discussion, 100% of survey respondents indicated that they were very helpful (highest ranking possible).
Discussion This pilot study demonstrated that concise one-page educational summaries, paired with case-based discussions, effectively increased participants' comfort in managing hematologic and oncologic complications. Building on this preliminary success, we aim to broaden this program's reach to include additional physicians and advanced practice providers who work as hospitalists, nocturnists, or in the emergency medicine and pulmonology/critical care spaces, locally, nationally, and internationally. As specialists, it is our duty and privilege to help educate our colleagues in managing this population and this in turn will directly impact patient outcomes and safety. We are hopeful that, in doing so, our cancer patients will receive optimal care regardless of their care team and location.
