abstract
PURPOSE:
Genomic
testing improves outcomes for many at-risk individuals and patients
with cancer; however, little is known about how genomic testing for
non-small-cell lung cancer (NSCLC) and colorectal cancer (CRC) is used
in clinical practice.
PATIENTS AND METHODS:
In
2012 to 2013, we surveyed medical oncologists who care for patients in
diverse practice and health care settings across the United States about
their use of guideline- and non-guideline-endorsed genetic tests.
Multivariable regression models identified factors that are associated
with greater test use.
RESULTS:
Of
oncologists, 337 completed the survey (participation rate, 53%).
Oncologists reported higher use of guideline-endorsed tests (eg, KRAS
for CRC; EGFR for NSCLC) than non-guideline-endorsed tests (eg, Onco
typeDX Colon; ERCC1 for NSCLC). Many oncologists reported having no
patients with CRC who had mismatch repair and/or microsatellite
instability (24%) or germline Lynch syndrome (32%) testing, and no
patients with NSCLC who had ALK testing (11%). Of oncologists, 32%
reported that five or fewer patients had KRAS and EGFR testing for CRC
and NSCLC, respectively. Oncologists, rather than pathologists or
surgeons, ordered the vast majority of tests. In multivariable analyses,
fewer patients in nonprofit integrated health care delivery systems
underwent testing than did patients in hospital or office-based
single-specialty group settings (all P < .05). High patient volume
and patient requests (CRC only) were also associated with higher test
use (all P < .05).
CONCLUSION:
Genomic
test use for CRC and NSCLC varies by test and practice characteristics.
Research in specific clinical contexts is needed to determine whether
the observed variation reflects appropriate or inappropriate care. One
potential way to reduce unwanted variation would be to offer widespread
reflexive testing by pathology for guideline-endorsed predictive somatic
tests.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.