Janet Roberts, Shahin Jamal, Marie Hudson, Aurore Fifi-Mah, Carrie Ye, The Canadian Research group of Rheumatology in Immuno-Oncology (CanRIO)

Title:  Rheumatic complications of cancer Immunotherapy:  Answering the call and meeting the educational needs of Canadian Rheumatologists

Background:  Immunotherapy, including the use of immune checkpoint inhibitors (ICI), has revolutionized the treatment of many advanced stage malignancies.  These agents are associated with a host of immune related side effects termed immune-related adverse events (IrAE) including those of a rheumatic nature (Rh-irAE).  As the indications for ICI increases rheumatologists will be increasingly called upon to co-manage patients who develop de novo Rh-irAE and those with pre-existing rheumatic disease (PRD) receiving ICI, with our oncology colleagues.  This is a rapidly evolving area of medicine with no evidence-based recommendations to assist rheumatologists in the management of this patient population.  The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) is a network of rheumatologists with interest and expertise in the management of this patient population.  A needs assessment of Canadian Rheumatologists conducted by CanRIO highlighted important knowledge gaps in this emerging field of Rh-irAE and provided the rationale for the development of educational initiatives.¹

Objectives:  CanRIO developed and presented a small group case-based educational session at the 2020 Canadian Rheumatology Association Annual Scientific Meeting, which addressed the 4 most common Rh-irAE and the management of PRD.   The primary objective was to educate rheumatologists on these topics but also to evaluate the effectiveness of interactive case-based learning modules.

Methods:  To evaluate the pre and post-session level of knowledge on the topics presented and as a marker of knowledge acquisition, a voluntary pre and post questionnaire was distributed to all participants.  The questionnaire included 10 questions covering inflammatory arthritis, myositis, vasculitis, sarcoidosis and PRD and was distributed to participants both prior to and following the educational session.

Results:  Pre- and post-workshop questionnaires were completed by 28 attendees.  Pre- and post-questionnaires were not individually linked, however, overall there was an increase in questionnaire scores from an average of 3.7 pre- to 6.7 post-workshop (scored out of 10).

Conclusions:  CanRIO has identified significant knowledge gaps in the emerging field of Rh-irAE.  A small group case-based educational session resulted in knowledge acquisition.  This session, including the base-based format and pre- and post-questionnaires will form the basis of interactive online educational modules that are currently being developed through the support of a Canadian Initiatives for Outcomes in Rheumatology cAre (CIORA) grant.  Future research will focus on long-term knowledge acquisition with questionnaires sent to participants 3-6 months following module completion.

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