How Practice Settings Shape Patient Care in Low-Risk MDS

When we receive a serious diagnosis like MDS, we often wonder if our options would be different in another clinic, which is why it’s important to get second opinions. However, the study we summarized here wanted to understand why healthcare professionals consider different treatment approaches and whether those differences exist between community hospitals and academic medical centers.

Being aware of these differences might help you advocate for yourself and get the best care, regardless of where you live. 

A Nationwide Study on Treatment Decisions 

In April 2024, a nationwide study examined how healthcare providers make treatment decisions for low-risk MDS and the challenges they face. It compared the approaches of community-based and academic hematology/oncology professionals. 

The results highlight key differences in treatment decision-making and barriers to optimal care.

Although this survey was sent to nearly 30,000 health professionals, 133 healthcare providers participated, highlighting the need for more involvement in this type of research. Patients had an average age of 50 years. The respondents included physicians (67%), nurses (17%), nurse practitioners (5%), and pharmacists (8%). 

Half of the participants worked in community practices, 37% in academic institutions, and 12% in outpatient infusion centers.

Access to Diagnostic Resources

An accurate diagnosis is essential to receiving the best initial care, which reduces the disease burden and improves symptoms. Receiving a precise diagnosis depends not only on the physician’s ability but also on the diagnostic tools available. 

This study also assessed how access to essential diagnostic tools varied depending on the provider's workplace:

• 86% of academic providers had an in-house pathologist, compared to only 23% of community providers.

• 44% of academic providers had in-house genetic testing, while only 15% of community providers did.

These differences suggest that patients in academic settings may have faster access to genetic and molecular testing, which can influence treatment choices.

You can keep learning the importance of genetic testing in MDS in this webinar where an MDS specialist solves all your questions! 

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Treatment Utilization

People diagnosed with myelodysplastic syndromes often experience anemia, and many require red blood cell transfusions and treatment to reduce complications associated with low blood counts. Treatment decisions are based on the risk of treatments not being effective enough long-term (whether a patient is high-risk or low-risk).  

No significant differences were found between academic and community healthcare providers (HCPs) regarding the frontline treatment choices for lower-risk MDS (LR-MDS) patients.

Both groups reported similar use of:

• Erythropoiesis-stimulating agents (ESAs) 
• Luspatercept
• Lenalidomide
• Hypomethylating agents (HMAs)
• Immunosuppressive therapy

We have an in-depth article explaining the treatments used for MDS here.

What Factors Influence Treatment Decisions?

When it comes to making treatment decisions, there's more to consider than just what might work best medically. Both healthcare providers and patients face different challenges that can affect these important choices.

Let's look at what healthcare providers struggle with:

• In academic centers, doctors often find it challenging to determine which patients would benefit most from new therapies – about 42% report this as a major concern. They also struggle with incorporating genetic information into their treatment decisions, with 48% finding this difficult.

• 65% of community providers found it hard to apply the latest treatment guidelines to real-world practice, and 64% say they need more expertise in managing the side effects of newer treatments.

But that's only half the story. Patients face their own set of challenges when it comes to getting treatment:

• Academic providers noted that their patient’s biggest barriers were medication costs and insurance coverage. Many patients also feel uncertain about starting treatment, which can delay their care.

• For patients seeing community providers, the challenges are more practical, like figuring out transportation to appointments, finding caregiving support, and managing long travel distances to cancer centers.

When Should Treatment Begin? 

While both academic and community providers used similar treatments, they differed in when they initiated therapy:

Both, community and academic providers, heavily rely on transfusion needs to decide if treatment needs to be initiated, but they differ on the threshold they use:

• 64% of community providers started treatment if a patient needed one unit of blood every two months.
• 28% of academic providers started treatment when a patient required two units per month.

Physicians can also consider hemoglobolin levels the identify those patients that need treatment. However,it seems that academic providers are more keen to use this  (40%) compared to community providers (15%). There were also discrpancies in the level of hemoglobin: some starting when hemoglobolin is below 9 g/dL, and others when it is even lower, below 8 g/dL. These differences suggest that patients in different practice settings may receive treatment at varying stages of their disease.

What This Means for Patients and Healthcare Providers

This study highlights important variations in how low-risk MDS treatment decisions are made across different healthcare settings. Understanding these differences can help patients have more informed discussions with their healthcare providers about their treatment options.

If you or a loved one has MDS, consider discussing with your doctor how your individual condition, including your transfusion needs and hemoglobin levels, may influence treatment decisions. It is important for to find a healthcare professional that remains updated on patient-centered care approaches and emerging treatment guidelines. With HealthTree you can use our Specialist Directory which allows you to browse near your area.

If you want to read more about treatment advances, clinical trial updates and conference highlights, you can bookmark the HealthTree News page to browse our articles, written just for you! 

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Source:

• Differences in Treatment Decision-Making in Frontline Management of Lower-Risk Myelodysplastic Syndromes between Academic and Community Practice Settings: Results from a Nationwide Survey