Utilization of epidermal growth factor receptor (EGFR) testing in the United States: a case study of T3 translational research

Abstract

Purpose We examined hospital use of the epidermal growth factor receptor (EGFR) assay for lung cancer patients. Our goal was to inform the development of a model to predict T3 translation of guideline-directed, molecular diagnostic tests. Methods This was a retrospective observational study. Using logistic regression, we analyzed the association between likelihood to order the EGFR assay and hospital’s institutional and regional characteristics. Results Significant institutional predictors included: Affiliation with an academic medical center (odds ratio [OR], 1.48; 95% CI, 1.20–1.83), Participation in an NCI clinical research cooperative group (OR, 2.06, 1.66–2.55), PET scan (OR, 1.44, 1.07–1.94) and cardio thoracic surgery (OR, 1.90, 1.52–2.37) services. Significant regional predictors included: Metropolitan county (OR, 2.08, 1.48 to 2.91), Above average education (OR, 1.46, 1.09 to 1.96), Above average income (OR, 1.46, 1.04–2.05). Distance from an NCI cancer center was a negative predictor (OR, 0.996, 0.995–0.998), a 34% decrease in likelihood for every 100 miles. Conclusion In 2010, 12% of US acute care hospitals ordered the EGFR assay, suggesting most lung cancer patients did not have access to this test. This case study illustrated the need for: 1) Increased dissemination and implementation research. 2) Interventions to improve adoption of guideline-directed, molecular diagnostic tests by community hospitals.

Implementation of the 21-gene recurrence score test in the United States in 2011

“…Our previous research identified substantial underuse of genomic tests among hospitals located in nonmetropolitan counties that are distant from NCI cancer centers. 22 Medicaid coverage for the 21-gene test became available in 2007. However, a study conducted in New York City found that site of care significantly influenced utilization, and women treated at municipal hospitals were unlikely to get the 21-gene test even after Medicaid coverage should have ensured equal access.…”

“…When compared with lung cancer molecular testing, 22 implementation of the 21-gene breast cancer test is widely distributed across the country. Although the percentage of patients tested ranged from 11.96 to 73.00%, this range is not particularly broad, especially given potential variations in age, comorbidities, stage, and incidence of ER+ breast cancer.…”

“…In this study, we measured nationwide utilization of the 21-gene test performed in calendar year 2011. Based on previously published research analyzing implementation of genomic medicine, 8,[20][21][22] we hypothesized that, despite rapid adoption of the 21-gene test, 19 there would be regional and site-of-care variations, as well as use that departs from clinical practice guidelines. To test this hypothesis, we compared total test orders per county to the number of newly diagnosed breast cancer cases.…”

“…Based on a previous study that analyzed implementation of a lung cancer molecular test, 22 it was expected that the hospital characteristics, including affiliation with an academic medical center, participation in an NCI cooperative group, availability of positron emission tomography scan services, and having a CLIA-accredited high-complexity laboratory, would be positively associated with likelihood to order genomic tests. For this analysis, we added availability of reconstructive surgery to the model because hospitals offering this service are likely to perform breast cancer mastectomies and reconstruction.…”

Whole-Genome Sequencing of Asian Lung Cancers: Second-Hand Smoke Unlikely to Be Responsible for Higher Incidence of Lung Cancer among Asian Never-Smokers

“…Physicians in both Western and Asian hospitals tend to order EGFR first-line testing for never-smoking patients with NSCLC (40,41). In Singapore, all patients are tested for EGFR mutations regardless of smoking status.…”