Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration

Abstract

BackgroundCurrent clinical guidelines recommend epidermal growth factor receptor (EGFR) mutational testing in patients with metastatic non-small cell lung cancer (NSCLC) to predict the benefit of the tyrosine kinase inhibitor erlotinib as first-line treatment. Proteomic (VeriStrat) testing is recommended for patients with EGFR negative or unknown status when erlotinib is being considered. Departure from this clinical algorithm can increase costs and may result in worse outcomes. We examined EGFR and proteomic testing among patients with NSCLC within the Department of Veterans Affairs (VA). We explored adherence to guidelines and the impact of test results on treatment decisions and cost of care.MethodsProteomic and EGFR test results from 2013 to 2015 were merged with VA electronic health records and pharmacy data. Chart reviews were conducted. Cases were categorized based on the appropriateness of testing and treatment.ResultsOf the 69 patients with NSCLC who underwent proteomic testing, 33 (48%) were EGFR-negative and 36 (52%) did not have documented EGFR status. We analyzed 138 clinical decisions surrounding EGFR/proteomic testing and erlotinib treatment. Most decisions (105, or 76%) were concordant with clinical practice guidelines. However, for 24 (17%) decisions documentation of testing or justification of treatment was inadequate, and 9 (7%) decisions represented clear departures from guidelines.ConclusionEGFR testing, the least expensive clinical intervention analyzed in this study, was significantly underutilized or undocumented. The records of more than half of the patients lacked information on EGFR status. Our analysis illustrated several clinical scenarios where the timing of proteomic testing and erlotinib diverged from the recommended algorithm, resulting in excessive costs of care with no documented improvements in health outcomes.

The Measurements and an Elaborated Understanding of Chinese eHealth Literacy (C-eHEALS) in Chronic Patients in China

“…Several limitations of this study should be addressed. First, a variety of health-related information and services in China may be found on popular social media sites such as WeChat, Sina Weibo, or Tudou Youku, or on specific health-related platforms (e.g., Keep) [ 8 ]. Comprehensive analysis of the current diversity of online media to address hybrid social media issues was not performed.…”

“…This did not change any words and all words had equivalent translations. However, two top search tools—an instant messaging app (i.e., Tencent’s Quick Question (QQ)) and a search engine forum (i.e., Baidu) [ 8 ]—in the nine-item scale on media and information channel use were specified to allow the questionnaire to be more applicable for the acquisition of health information in China.…”

“…For example, low health literacy has been associated with obesity [ 1 , 2 ], low adoption of health behaviours [ 3 , 4 , 5 ], poor use of health care services [ 6 , 7 ] and poor access to electronic health (eHealth) resources [ 5 ]. The rapid rise of Internet-based technologies that disseminate health information and services enhances the acquisition of online health information [ 8 , 9 , 10 ]. Therefore, eHealth literacy has drawn the attention of researchers as a condition for utilising such information and services [ 8 , 11 , 12 ].…”

“…The rapid rise of Internet-based technologies that disseminate health information and services enhances the acquisition of online health information [ 8 , 9 , 10 ]. Therefore, eHealth literacy has drawn the attention of researchers as a condition for utilising such information and services [ 8 , 11 , 12 ].…”

Clinical Molecular Marker Testing Data Capture to Promote Precision Medicine Research Within the Cancer Research Network

“…[24][25][26] Inappropriate use of targeted therapies in patients who have not undergone required or recommended testing or who do not have the correct therapeutic target(s) has been previously demonstrated. 27,28 Thus, it is important for health care systems to be able to evaluate the use and results of molecular assays, genetic testing, and targeted therapies, along with their impacts on patient outcomes.…”