Utilization of genomic testing in advanced non-small cell lung cancer among oncologists in the Veterans Health Administration

Arney, Jennifer; Helm, Ashley; Crook, Travis W.; Braun, Ursula K.; Chen, G. John; Hayes, Teresa G.

doi:10.1016/j.lungcan.2017.12.006

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Inclusion of mutation testing into the real-world treatment of aNSCLC patients has been widely discussed in scientific literature [30][31][32][33][34][35]. For example, a study using US claims data reported that 18% of newly diagnosed patients with metastatic lung cancer had claims for EGFR testing within 6 months following diagnosis [30].…”

Section: Discussionmentioning

confidence: 99%

“…For example, a study using US claims data reported that 18% of newly diagnosed patients with metastatic lung cancer had claims for EGFR testing within 6 months following diagnosis [30]. In qualitative interviews with oncologists treating NSCLC patients in the US, only a minority reported testing every patient regardless of stage, histology, age and smoking status [32]. On the other hand, an example from the Netherlands showed that implementation of guideline recommendations into clinical practice in four hospitals increased the mutation testing rate from 20 •8% to 74•4% within 6 years [36].…”

Section: Discussionmentioning

confidence: 99%

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Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Myers

Cizova

et al. 2020

BMC Cancer

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Background: The objective of this study was to describe the real-world treatment and overall survival (OS) of German patients with a diagnosis of advanced non-small cell lung cancer (aNSCLC), and to explore factors associated with the real-world mortality risk. Methods: This was a retrospective German claims data analysis of incident aNSCLC patients. Data were available from 01/01/2011 until 31/12/2016. Identification of eligible patients took place between 01/01/2012-31/12/2015, to allow for at least 1-year pre-index and follow-up periods. Inpatient and outpatient mutation test procedures after aNSCLC diagnosis were observed. Further, prescribed treatments and OS since first (incident) aNSCLC diagnosis and start of respective treatment lines were described both for all patients and presumed EGFR/ALK/ROS-1-positive patients. Factors associated with OS were analyzed in multivariable Cox regression analysis. Results: Overall, 1741 aNSCLC patients were observed (mean age: 66•97 years, female: 29•87%). The mutation test rate within this population was 26•31% (n = 458), 26•6% of these patients (n = 122) received a targeted treatment and were assumed to have a positive EGFR/ALK/ROS-1 test result. Most often prescribed treatments were pemetrexed monotherapy as 1 L (21•23% for all and 11•11% for mutation-positive patients) and erlotinib monotherapy as 2 L (25•83%/38•54%). Median OS since incident diagnosis was 351 days in all and 571 days in mutation-positive patients. In a multivariable Cox regression analysis, higher age, a stage IV disease, a higher number of chronic drugs in the pre-index period and no systemic therapy increased the risk of early death since first aNSCLC diagnosis. On the other hand, female gender and treatment with therapies other than chemotherapy were associated with a lower risk of early death. Conclusions: Despite the introduction of new treatments, the real-world survival prognosis for aNSCLC patients remains poor if measured based on an unselected real-world population of patients. Still, the majority of German aNSCLC patients do not receive a mutation test.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Myers

Cizova

et al. 2020

BMC Cancer

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“…138 While most studies found that oncology providers were positive about mainstreaming, others were concerned that mainstreaming would increase workload beyond capacity. 138,139 Five studies that described oncologists' ordering practices for genetic testing on tumor samples for treatment decision-making purposes found that oncologists tended to order more genetic tests [140][141][142][143][144] than were recommended by professional guidelines. 145 There were several additional studies that compared genetics providers and nongenetics HCPs.…”

Section: Case Loadsmentioning

confidence: 99%

The composition and capacity of the clinical genetics workforce in high-income countries: a scoping review

Dragojlovic

Borle

Kopac

et al. 2020

Genetics in Medicine

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As genetics becomes increasingly integrated into all areas of health care and the use of complex genetic tests continues to grow, the clinical genetics workforce will likely face greatly increased demand for its services. To inform strategic planning by health-care systems to prepare to meet this future demand, we performed a scoping review of the genetics workforce in high-income countries, summarizing all available evidence on its composition and capacity published between 2010 and 2019. Five databases (MEDLINE, Embase, PAIS, CINAHL, and Web of Science) and gray literature sources were searched, resulting in 162 unique studies being included in the review. The evidence presented includes the composition and size of the workforce, the scope of practice for genetics and nongenetics specialists, the time required to perform genetics-related tasks, case loads of genetics providers, and opportunities to increase efficiency and capacity. Our results indicate that there is currently a shortage of genetics providers and that there is a lack of consensus about the appropriate boundaries between the scopes of practice for genetics and nongenetics providers. Moreover, the results point to strategies that may be used to increase productivity and efficiency, including alternative service delivery models, streamlining processes, and the automation of tasks.

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“…Some clinicians may be reluctant to offer NTRK fusion testing, or a HI technology in the tumour types where the mutation is very rare or unknown, which may make it difficult for clinicians to manage patient expectations if they know a drug has histology-independent approval. 9…”

Section: Key Considerations Impact On Decision-making Prevalence Of M...mentioning

confidence: 99%

Appraising the Costs of Genomic Testing for Histology-Independent Technologies: An Illustrative Example for NTRK Fusions

Beresford¹,

Murphy²,

Dias³

et al. 2022

Value in Health

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Utilization of genomic testing in advanced non-small cell lung cancer among oncologists in the Veterans Health Administration

Cited by 5 publications

References 11 publications

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

Real-world treatment and survival of patients with advanced non-small cell lung Cancer: a German retrospective data analysis

The composition and capacity of the clinical genetics workforce in high-income countries: a scoping review

Appraising the Costs of Genomic Testing for Histology-Independent Technologies: An Illustrative Example for NTRK Fusions

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