Each year in the United States, several thousand persons are diagnosed with metastatic cancer whose primary cancer site is unknown, according to the National Cancer Institute, and approximately 2 to 4 percent of all cancer patients have a cancer whose primary site is never identified. Cancer of unknown primary (CUP) origin is diagnosed when a metastatic cancer is found, for example, in the lung, but physicians cannot determine whether the cancer originated in the breast or another organ. This is a significant challenge for physicians—and potentially a life-or-death issue for patients with CUP—because a treatment designed for the primary cancer is likely to be more effective.
Pamela Messer Peters ’79, a director and education-grants specialist for Medscape, is developing an online continuing medical education (CME) program to inform physicians about the magnitude of this problem and new genomic analyses that can help them make the right call.
“I’m really excited about the explosive growth of knowledge about the impact of individual genetic phenotypes on the body’s ability to metabolize and use various medicines,” says Peters, who earned her doctoral degree in biology and genetics at Yale University. “Through genomic analysis, it is increasingly possible to look at an individual’s genetic make-up to help determine optimum therapeutic protocols.
“This is changing the face of treatment in oncology,” Peters says. “I believe that this is the beginning of a change in the way medicine is practiced: it is the advent of personalized medicine.”
Peters identifies scientific and clinical issues and associated knowledge gaps among practitioners in the field of oncology, develops proposals for CME programs designed to fill those gaps, and identifies potential supporters—sometimes foundations, but more often pharmaceutical or biotech companies—that can provide funding to support educational programming on Medscape. Part of the professional arm of WebMD, Medscape offers online medical information and education to physicians and other health-care professionals. Physicians, nurses, pharmacists, and other medical practitioners must earn a certain number of CME credits each year to retain their licenses.
A “Better Way”
In one of her recent projects, Peters collaborated on a CME program with a small start-up company that has developed genomic analyses that can be used to identify the original site of a CUP. Until a year ago, she explains, an online CME program about this issue would have focused on how the pathologist identifies the primary origin of a metastatic cancer using microscopic analysis of stained cells from a tissue sample. “Now we can say, ‘here’s an even better way: we can go deeper and look at the genomic profile of these cells.”
In designing a CME program, Peters and her colleagues—Medscape editors, adult-learning specialists, oncologists and others—focus not only on the data but also on the best and most efficient way to communicate these data to physicians and other health-care providers. The program might include an audio lecture with slides, an interactive discussion, and/or a videotaped expert roundtable discussion. Content is developed by clinical and research experts who specialize in the topic being discussed.
“A real challenge is understanding how to educate professional adults in an effective manner,” Peters says. “Everybody is different: some want to hear the information, others want to see it, and either approach is valid.”
Peters plans to build her program about CUP origin in three steps: an audio lecture accompanied by a series of synchronized biopsy slides; an interactive moderated panel discussion among an oncologist, pathologist, and nurse; and a simulated examination of a patient.
Although it is not required under the CME requirements, Medscape performs a follow-up analysis of each program to determine whether or not physicians learned the information and applied it in their practices, and whether or not it affected patients’ health outcomes.
Guarding Against Bias
Peters says one of her biggest challenges is producing CME programs within a complex legal environment. “Everybody from top to bottom wants to be sure that CME is free from bias,” she says, “and there are extensive legal restrictions to ensure that this happens”
Just as we are on the verge of individualized medicine, Peters says, “We also have an increased ability to personalize and individualize online education. Learners will be able to go online and take a test or use a learning tool to identify their learning gaps, and then have a live interactive experience in this online environment.
“What an impact this personalized education will have on the practice of medicine!”
Dorothy Wright contributes news and feature articles on science, technology, engineering, and general-interest topics to a variety of publications, including Civil Engineering and Engineering News Record.