While randomized trials are the gold standard in research, the need for real-world data is eminent. Real-world data can generate insights from routine health care and close the gap between research and routine clinical practice. New therapies and care delivery models should be assessed across diverse populations and real-life settings. The feature articles in this issue explore real-world use of newer medications and perspectives on care delivery with specific disease settings and facilities.
Over the past decade, the treatment landscape for chronic myeloid leukemia (CML) has evolved significantly with the availability of generic imatinib and the introduction of second- and third-generation tyrosine kinase inhibitors (TKIs). While TKI therapy has improved survival for many patients, real-world prescribing of TKIs can be a challenge for providers trying to balance choosing first-line drug therapy, maximizing patient adherence, and switching TKIs appropriately. In addition, studies have demonstrated that more than 25% of patients may not be adherent to TKI therapy in real-world settings, with low adherence representing a major risk factor for poor treatment outcomes. In their Research Report, Henry J Henk, PhD, and colleagues report the findings of their retrospective analysis studying the impact of a generic entry by comparing trends in treatment selection, switching, adherence, and molecular monitoring for patients initiating TKI treatment between 2007 and 2017. The use of observational data in the study provides an alternate to the clinical trial perspective, offering insight into CML treatment patterns in real-world practice, where providers can choose between several TKIs for first-line treatment of CML.
Groups like the American Society of Clinical Oncology and the American Society of Hematology have worked to support advanced payment models and cancer quality improvement by developing quality measures for physician benchmarking. While many measures have been implemented, there are important gaps in measures for less prevalent cancers, such as multiple myeloma (MM). With the approval of lenalidomide in 2007 for the treatment of newly diagnosed MM, there has been dramatic improvements in patient prognosis. Since then, new treatment combinations that combine different routes of administration and dosing schedules, and which have complex safety-monitoring requirements, have also been approved. Community oncology practices that dispense lenalidomide face complexity in coordinating the care between orally administered and intravenous regimens, educating patients, and delivering (or administering) lenalidomide and its combination partners to derive the greatest clinical benefit without compromising safety. Stacey W McCullough, PharmD, and colleagues employed the narrative method of qualitative research to understand gaps in quality and measurement facing community oncology practices from the physician, supporting staff (including nurses), and pharmacy point of view to identify areas for quality improvement, recommend interventions to improve quality, and identify opportunities for new measures to benchmark care quality and drive improvement in MM care.
