This study was funded by Anthem. Adeboyeje, Sylwestrzak, and Barron are employees of HealthCore, a wholly owned and independently operated subsidiary of Anthem. White, Rosenberg, Abarca, and Crawford are employees of Anthem. Study concept and design were primarily contributed by Adeboyeje and Sylwestrzak, along with the other authors. Adeboyeje took the lead in data collection, along with Sylwestrzak and Barron. Data interpretation was performed primarily by Rosenberg, Crawford, and Redberg, with assistance from the other authors. The manuscript was written by all the authors and revised primarily by White, Abarca, and Redberg, along with the other authors.

These findings demonstrate that a decision support-enabled utilization management tool can improve risk-appropriate, guideline-adherent CSF use in patients with lung cancer.

There is significant improvement in the outcomes following treatment with PARP inhibitors among patients with certain tumors that have BRCA mutations (BRCAm), homologous recombination repair (HRR) gene mutations, or homologous recombination deficiency (HRD) positivity. We performed a literature review and meta-analysis to evaluate the prevalence of BRCA1/2m, HRR gene mutations, and HRD positivity across multiple cancers. There were 265 publications on BRCA1/2 mutation prevalence, 189 on HRR gene mutation prevalence, and 7 on HRD positivity prevalence.The prevalences of germline BRCA1m and BRCA2m were 7.8% and 5.7% for breast cancer, 13.5% and 6.6% for ovarian cancer, 0.5% and 3.5% for prostate cancer, and 1.1% and 4.1% for pancreatic cancer, respectively. The prevalences of somatic BRCA1m and BRCA2m were 3.4% and 2.7% for breast cancer, 4.7% and 2.9% for ovarian cancer, 5.7% and 3.2% for prostate cancer, and 1.2% and 2.9% for pancreatic cancer, respectively. We identified 189 studies with over 418,649 samples across 25 tumor types that examined mutations in one or more HRR genes other than BRCA1/2. The prevalence of mutations among HRR genes remained low (less than 1%), with ATM (5.2%), CHEK2 (1.6%), and PALB2 (0.9%) exhibiting the highest prevalence. Seven studies evaluated HRD positivity in breast, ovarian, and prostate cancer patients. The prevalence of HRD positivity was 56% overall (95% CI = 48%-64%).The understanding of biomarker prevalence across tumor types and standardization of biomarker assays could have important clinical implications.

BackgroundDifferent outcomes among patients hospitalized for bleeding after starting anticoagulation could influence choice of anticoagulant. We compared length of hospitalization, proportion of Intensive Care Unit (ICU) admissions, ICU length of stay, and 30- and 90-day mortality for adults with atrial fibrillation hospitalized for bleeding after starting warfarin, dabigatran, or rivaroxaban.MethodsAn US commercial database of 38 million members from 1 November 2010 to 31 March 2014 was used to examine adults with atrial fibrillation hospitalized for bleeding after starting warfarin (2,446), dabigatran (442), or rivaroxaban (256). Outcomes included difference in mean total length of hospitalization, proportion of ICU admissions, mean length of ICU stay, and all-cause 30- and 90-day mortality.ResultsWarfarin users were older and had more comorbidities. Multivariable regression modeling with propensity score weighting showed warfarin users were hospitalized 2.0 days longer (95% CI 1.8–2.3; p < 0.001) than dabigatran users and 2.6 days longer (95% CI 2.4–2.9; p < 0.001) than rivaroxaban users. Dabigatran users were hospitalized 0.6 days longer (95% CI 0.2–1.0; p = 0.001) than rivaroxaban users. There were no differences in the proportion of ICU admissions. Among ICU admissions, warfarin users stayed 3.0 days (95% CI 1.9–3.9; p < 0.001) longer than dabigatran users and 2.4 days longer (95% CI 0.9–3.7; p = 0.003) than rivaroxaban users. There was no difference in ICU stay between dabigatran and rivaroxaban users. There were no differences in 30- and 90-day all-cause mortality.ConclusionsRivaroxaban and dabigatran were associated with shorter hospitalizations; however, there were no differences in 30- and 90-day mortality. These findings suggest bleeding associated with the newer agents is not more dangerous than bleeding associated with warfarin.

e18754 Background: The value of using next-generation sequencing (NGS) to inform oncology care decisions is increasingly apparent, yet many challenges persist that may inhibit routine adoption of NGS into clinical care. The purpose of this study was to identify existing barriers to NGS access and possible solutions from the physician perspective. Methods: A cross-sectional online survey, including both closed- and open-ended questions, was sent to a nationally representative sample of oncologists/hematologists, surgeons, and pathologists (N=201). The survey gathered information on physician demographics, practice characteristics, perceived barriers to testing, and strategies for increasing adoption. Results: Over 99% of physicians, 20.5% of whom worked in an academic setting, reported using NGS in the past 12 months, and 73.0% used NGS always or most of the time. Despite this high utilization, 80.1% of physicians experienced at least one barrier to testing. Reimbursement challenges were among the top reported barriers (87.5%), followed by a lack of knowledge of NGS testing methodologies (81.0%), and lacking evidence of clinical utility (80.1%). These barriers were more likely to be reported by pathologists and surgeons compared to oncologists/hematologists. Potential strategies for addressing these differed by specialty: While most oncologists/hematologists (84.0%) reported increased NGS coverage as a top priority, most surgeons (88.0%) prioritized improved multidisciplinary communications, and most pathologists (84.4%) prioritized increased access to educational content on cancer genomics and resources for physicians. Conclusions: Despite the high utilization of NGS among the surveyed stakeholders, several barriers, including limited reimbursement, knowledge gaps, and lack of clinical utility evidence were reported that may impact clinical optimization. Interestingly, the perceived barriers to NGS use varied by specialty, which may be driven by the differing roles these specialists play in patient management. Oncologists/hematologists, who are more likely involved in long-term patient care, were most concerned with identifying strategies to improve coverage of technology, whereas surgeons and pathologists were most concerned with strategies that would improve understanding and education. This research highlights the need for multi-faceted strategies to address barriers to NGS adoption. [Table: see text]