Janet Roberts, Kevin Lau, Daniel Ennis, Marie Hudson, Shahin Jamal, Steven Katz, Carrie Ye

 Title:  A web-based education program improves health care provider knowledge for the care of cancer patients receiving immunotherapy who develop rheumatic immune-related complications, and those with pre-existing rheumatic disease:  An Initiative of CanRIO (Canadian Research Group of Rheumatology in Immuno-Oncology)

Background:  Immunotherapy has revolutionized the treatment of many advanced stage malignancies.  These agents harness the immune system to fight cancer.  However, use of these agents leads to many off-target effects known as immune-related adverse events (irAE).  The management of patients with rheumatic immune-related adverse events (Rh-irAE) as well as cancer patients with pre-existing autoimmune rheumatic disease (PAD) is challenging as treatment of their rheumatic disease can lead to attenuation of the cancer therapy.  This is a rapidly evolving area of medicine and previous studies have shown that many rheumatologists lack experience, knowledge and confidence in the management of these patients.^1,2

Purpose:  To improve the knowledge of health care providers on two specific patient populations: (i) cancer patients who develop de-novo Rh-irAE and (ii) patients with PAD being treated with immunotherapy.  Our goal was to achieve knowledge transfer through the development of an educational platform that facilitates cross-discipline and transregional collaboration and to support health care providers caring for these patients to ensure educational resources are both available and easily accessible.

 Methods:  We developed multiple tools to facilitate knowledge acquisition and transfer including a) five case-based learning modules (with pre- and post-module tests), b) interactive bi-monthly video conferences, and c) development of a website to house educational resources.   This website (www.canrio.ca) houses the learning modules, registration for video conferences, as well as other educational resources for health care providers.  Google Analytics is embedded within the www.canrio.ca website and was used to track website traffic since the website’s inception in February 2021.  Immediate knowledge acquisition was assessed following completion of the learning modules by comparing mean pre- and post-module test scores.  Long-term knowledge retention was assessed by test scores 3 months following completion of the learning module.

Results:  Between February 2021 and May 2022, 893 users from 36 different countries accessed the www.canrio.ca website.  The top three countries from which users accessed the site were Canada (59%), United States of America (17%) and China (15%).  The case-based learning modules resulted in immediate knowledge acquisition with a statistically significant increase from pre- to post-test scores for all five modules (Table 1).  Long-term knowledge retention remains unclear as only 14% of eligible users completed the 3-month follow-up test.

Conclusion: CanRIO.ca, a web-based, open access educational platform is an effective tool for delivering content and promoting knowledge acquisition on rheumatic complications of cancer immunotherapy to healthcare providers around the world.

References:

1. Maltez N, Abdullah A, Fifi-Mah A, Hudson M, Jamal S.  Checking in with immune checkpoint inhibitors: Results of a needs assessment survey of Canadian rheumatologists.  J Cancer Sci Therap 2019;2(1):12
2. Kostine M, Cappelli LC, Calabrese C, Calabrese L, Bingham CO et al.  Addressing immune-related adverse events of cancer immunotherapy: How prepared are rheumatologists.  Annals of the Rheumatic Diseases 2019;78:860.

 

Module     Topic	Pre-test     entries (number)	Post-test entries (number)	Retention test entries (number)	Pre-test      score (%)	Post-test      score (%)	Post-test p value (Reference: Pre-test score)	Retention     test score (%)	Retention test score p value (Reference: Pre-test score)
Ir-IA	30	18	3	3.83 (48)	6.61 (83)	P<0.0001	6.33 (79)	P=0.0747
Ir-Myositis	17	13	2	4.65 (58)	6.15 (77)	P=0.0366	6 (75)	P=0.4432
Ir-PAD	23	15	6	3.91 (49)	7.33 (92)	P<0.0001	5.67 (71)	P=0.1497
Ir-SLR	19	6	1	3.83 (48)	7 (88)	P<0.0001	4 (50)	n/a
Ir-Vasculitis	27	18	4	3.11 (39)	6.28 (78)	P<0.0001	6 (75)	P= 0.0006

Ir=immune related; IA = inflammatory arthritis; PAD = pre-existing autoimmune rheumatic disease; SLR=sarcoid-like reaction