In clinical trials, it is critical to ensure that tumor markers are evaluated in patients with conditions such as colorectal cancer (CRC). A recent study sought to understand how advanced practice provider (APP)-led education for clinical and research teams can help raise the rates of tumor marker detection in this setting.
Amanda Brink, DNP, APRN, FNP-BC, AOCNP, of the University of Texas MD Anderson Cancer Center, conducted the study and presented her findings during JADPRO Live 2023, the Annual APSHO Meeting.
It was important to conduct the research because APPs “play a vital role” in decision-making surrounding treatment, including evaluating a patient’s tumor marker, according to the presenter. Clinical and research teams collaborate to coordinate patient care in early-phase clinical trials.
“Initially, the research team drafts protocol-related orders for the APP’s signature,” the presenter noted. “However, the clinical team observed that these orders frequently omitted tumor markers, resulting in the team being unable to obtain crucial information about the patient’s treatment response when baseline measurements were unavailable.”
Because of this issue, the study assessed the effectiveness of an APP-led education initiative to improve the use of tumor markers for CRC and other conditions. The author of the study surveyed APPs and research teams to gain an understanding of their preferences for ordering tumor markers, finding all APPs agreed that “it was important to order tumor markers before the patient starts a new treatment.” Most APPs said they “believed it was the responsibility of the research team to order tumor markers,” and most members of the research team agreed with this statement, the presenter reported.
However, the study identified 2 main barriers to ordering tumor markers. Those barriers were “lack of knowledge regarding which tumor markers to order” and the absence of a requirement in the protocol to order tumor markers. Consequently, the author developed an educational presentation on tumor markers for the research and APP teams. The presentation covered the use of tumor markers in making decisions about treatment and provided a list of tumor markers by disease site. For CRC, the tumor markers were CEA and CA 19-9.
The researcher reviewed patient charts for the 3-month period preceding the educational initiative, finding that 73% of 236 patients who had a tumor type with an associated marker had their tumor marker drawn within 2 weeks of the first day of their first cycle of treatment. The objective of the educational intervention was to increase this rate to 90% or higher. The researcher reviewed patient charts for the 3-month period after the educational program, finding that 92% of 199 patients who had a tumor type with an associated marker had their tumor marker drawn within 2 weeks of the first day of their first cycle of treatment.
The presenter acknowledged some APPs preferred to obtain tumor markers with each new cycle of treatment, whereas others “preferred to do so only during restaging cycles.” She also outlined the implications and practical applications of the study and educational program.
“In a dynamic, early-phase, clinical trial clinic, new protocols with distinct requirements are continually introduced, along with a frequent influx of new study team members, including unlicensed personnel,” the presenter concluded. “Therefore, it is crucial to ensure that the APP-led education initiative for tumor markers is not a one-time occurrence. When writing protocols, clinicians may improve comprehensive patient assessment by including tumor marker measurement in protocol laboratory requirements.”
Brink A. Enhancing tumor marker utilization in early phase clinical trials: an APP-led education initiative. Presented at JADPRO Live 2023, the Annual APSHO Meeting; November 9-12, 2023; Orlando, Florida.