212 Background: Timely and appropriate biomarker testing guides evidence-based treatment decision-making in advanced non-small cell lung cancer (aNSCLC). American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines recommend that all treatment-eligible patients with non-squamous, or squamous histology in non-smokers undergo EGFR and ALK biomarker testing prior to initiating first line therapy. Genentech’s Learning and Clinical Integration team and Flatiron Health explored the frequency of EGFR/ALK testing and overall time between advanced disease diagnosis, results receipt and treatment initiation in clinical oncology practices. Methods: Structured and unstructured data were obtained from Flatiron’s electronic health record database. 6,991 patients from 166 clinics diagnosed after 1/1/14 with at least 2 visits before 8/31/15 were randomly selected from the Flatiron aNSCLC national cohort of > 25,000 patients. Dates of specimen collection, results receipt and treatment start were collected. Results: EGFR/ALK testing was conducted in 75% of non-squamous patients with wide variation across practices (< 20% to 100%). For squamous patients, 15% were tested overall, but with dramatic variation across practices (0% to 100%). For patients with a positive test result available prior to initiation of first line treatment, 79% of EGFR+ and 94% of ALK+ patients received the appropriate targeted therapy. However, for those patients tested after initiation of first line therapy, only 41% of EGFR+ and 65% of ALK+ patients received appropriate targeted first line therapy. EGFR/ALK tests results were received > 4 weeks from aNSCLC diagnosis in 32% and 34% of patients, respectively. Validation testing indicated that delays were attributed to non-lab factors, as test results were returned in < 2 weeks in 95% of cases. Conclusions: Wide variation in real-world practice illustrates the need to improve adherence to ASCO and NCCN biomarker testing guidelines. Educational intervention to improve quality of care in aNSCLC should focus on ensuring testing of almost all non-squamous patients, limiting testing to the non-smoking squamous cell population, and ensuring timely ordering of testing by clinicians.
19 Background: A significant thrust within recent innovation has been focused on improving the quality of diagnostics and system adherence to guidelines; equally important are attempts to improve patient-specific therapy plans, or personalized medicine. These two approaches—quality improvement and personalized medicine—have equally laudable goals toward improving cancer care and outcomes, yet have not been fully examined for their concomitant impacts, particularly among and within interprofessional teams, in which a mix of health care providers present varied foci within the oncology care delivery process. Methods: Twenty phone-based qualitative interviews were facilitated with community-based medical oncologists in active practice in July 2012. Transcripts of the interview sessions were examined through grounded qualitative analysis, and overall findings are presented. Results: Oncologists hold varied definitions of personalized medicine, yet share understanding of the central nature of the patient within personalized medicine care delivery. More varied are oncologists’ perceptions of the goals and value of implementation of quality improvement initiatives, which range from those focused on pragmatic concerns of the oncology clinic, such as patient flow, to the quality of clinical decision-making and outcomes. Oncologists value well-functioning and clearly defined roles within interprofessional teams within oncology practices, both among other clinicians and allied team members. However, functional and perceptional gaps remain in the practical application of quality improvement objectives within interprofessional teams and within the implementation of personalized oncology care delivery. Conclusions: This exploratory qualitative analysis approach provides grounded identification of practicing oncologists’ definitions of quality improvement, personalized medicine, interprofessional care delivery, and the practical interrelationships between these domains, enabling a framework for future research and quality initiatives.
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