Lung cancer biomarker testing decisions vary between academic and community oncologists

According to the survey results, far fewer community-based oncology clinicians than academic clinicians use biomarker tests to guide discussions with lung cancer patients.

The results – presented at the International Association for the Study of Lung Cancer (IASLC) world conference on lung cancer – showed that less than half of those surveyed in the community setting were using biomarker tests to guide patient discussions about prognosis, compared to nearly three-quarters of academic clinicians. .

“Our study identifies key areas of the continuing needs of clinicians related to biomarker testing, including better knowledge of the guidelines, practical applications of guideline-compliant testing, and how to optimally help coordinate multidisciplinary care,” researcher Leigh Boehmer, PharmD, The chief medical officer of the Association of Community Cancer Centers (ACCC) told Healio.

Advocacy groups and professional organizations should help develop impactful educational materials and tools to improve clinician-patient conversations about biomarker testing, Boehmer added.

A report released last year by the American Association for Cancer Research addressed disparities in the care of cancer patients. One section of the report focused on “the vagueness of precision medicine” due in part to a limited understanding of the etiology and genetics of cancer among underserved racial and ethnic populations.

Several factors can contribute to disparities in biomarker testing. These include environmental factors, access to quality health care, insurance status, patients’ mistrust of the health system, and the extent to which clinicians and patients understand the role important that biomarker testing can play in treatment decision-making, depending on the study setting.

Leigh boehmer

“The use of precision medicine was initially seen as an opportunity to address known disparities in care by determining treatment largely on the genetic makeup of a tumor or mutation,” said Boehmer. “In reality, the disparities have only grown due to the ability to pay / insurance status for tests, mistrust of the healthcare system and the mismatch between patients ‘and clinicians’ understanding of the importance of biomarker testing for treatment planning. Our study attempts to identify the obstacles inherent in the equitable supply of biomarker tests. [for] patients with non-small cell lung cancer to recommend specific interventions that can be implemented to optimize care.

Boehmer and his colleagues conducted a mixed-method survey of the attitudes and educational needs of oncology clinicians based in the United States regarding biomarker testing.

The researchers developed the survey instrument based on data analysis, coding of open-ended responses and sub-analyzes across demographic cohorts to identify differences in attitudes and decision making. The researchers also conducted two virtual groups to provide context to their data.

The objectives included the assessment of current practice patterns, barriers and required resources related to biomarker testing.

Eligible clinicians included those who treated patients with NSCLC who were not insured or covered by Medicaid, including dual-eligible beneficiaries.

Ninety-nine clinicians responded to the survey. Respondents included medical oncologists or hematologists / oncologists (40%), radiation oncologists or radiologists (20%), pulmonologists (15%), pathologists (8%), medical directors (8%), surgical oncologists (5%) and nurses, nurse coordinators or pivot nurses (2%).

Two-thirds of respondents (68%) practiced in a community setting and one-third (32%) practiced in a university setting.

“Two discoveries really jump out at me,” Boehmer told Healio.

First, only 40% of respondents indicated they were “very familiar” or “extremely familiar” with the molecular testing guidelines for lung cancer published in 2018 by the College of American Pathologists, IASLC and the Association. for Molecular Pathology.

Second, a significantly lower percentage of community clinicians than academic clinicians reported using biomarker tests to guide discussions with patients about prognosis (48% vs. 73%; P = .021).

“Both results demonstrate tremendous educational opportunities and greater engagement of oncology clinicians when addressing the critical role of biomarker testing,” said Boehmer.

A higher percentage of community clinicians reported ordering or recommending biomarker tests because the results influenced treatment decisions (88% vs. 82%. A higher percentage of academic oncology clinicians reported ordering or recommended tests because they are recommended in clinical practice guidelines% vs. 53%), the results may impact eligibility for enrollment in clinical trials (64% vs. 48%) and because patients expect molecular tests (12% vs. 9%).

The researchers also asked survey respondents about their preferences for making final decisions about testing. About half (52%) indicated that they preferred to make the final decision themselves, while 41% indicated that they preferred to share this responsibility with their patients. Six percent expressed a preference for the patient making the final decision.

Focus group discussions revealed perceptions among clinicians that patients rarely understand what tests involve and the role they play in guiding treatment.

When asked what resources are needed to help make decisions about biomarker testing, the most common responses included information about financial aid (26%), published guidelines (21%), better educational materials (14%), clinical data (10%), help from other oncologists (7%) and additional staff (3%).

About two-thirds of respondents (65%) provide printed educational material to their patients, 56% provide educational material online, and 44% provide financial advice. When researchers asked clinicians what resources their patients needed most, the most common responses included materials or educational resources (27%), psychosocial support (23%), and financial assistance (22%).

An intervention project is underway to pilot a lung cancer biomarker testing sequence of care plan designed to promote patient engagement and offer a coordinated treatment approach.

«In partnership with LUNGevity [Foundation] and the Center for Business Models in Healthcare, ACCC is actively developing a sequence of care plan with input from patients and providers to promote patient engagement and offer a coordinated approach to biomarker testing, ”Boehmer said at Healio. “At the heart of this model will be the creation of educational material, informed by patients and caregivers, which will be used by members of the multidisciplinary cancer care team when discussing the role and implications of biomarker testing. for patients with lung cancer. “

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