Quality Care 2019: Program Hastens Start of Bone-Modifying Agents in Myeloma
Posted: Monday, September 9, 2019
A group of clinicians at the Cleveland Clinic have implemented a quality improvement project in an effort to decrease the time to initiating bone-modifying agents in patients with newly diagnosed multiple myeloma. Although American Society of Clinical Oncology (ASCO) and International Myeloma Working Group (IMWG) guidelines recommend that all patients treated for myeloma receive a bone-modifying agent to decrease the risk of skeletal-related events, recent data indicate that just 51% of Medicare patients with myeloma receive this supportive care within 90 days of initiating chemotherapy.
“With increased physician education and awareness of internal baseline data, we achieved our initial goal and observed a significant improvement in time to start bone-modifying agents from 10.5 weeks to 4.3 weeks,” explained Sarah Lee, MD, of the Cleveland Clinic, and colleagues. Their efforts were presented at the 2019 ASCO Quality Care Symposium in San Diego (Abstract 65).
The researchers first identified barriers to starting bone-modifying agents using quality improvement tools developed at the ASCO Quality Training Program. The focus then shifted to educating providers, including a review of updated guidelines, literature review of risks and toxicities associated with the agents, and strategies for choosing bone-modifying agents based on patient factors.
The average time from the start of myeloma therapy and the start date of bone-modifying agents in 161 newly diagnosed patients with multiple myeloma from 2015 to 2018 was 10.5 weeks. After implementing the training program, the average time to the first dose of bone-modifying agents in 14 newly diagnosed patients was 4.3 weeks, and 86% of patients (n = 12) were treated with a bone-modifying agent.
“We plan to incorporate bone-modifying agent guidelines in our institutional care path with the goal to decrease time to initiation at all affiliated practices,” concluded Dr. Lee and colleagues.
Disclosure: The study authors reported no conflicts of interest.