STRATEGIES FOR INCREASING EGFR MUTATION TESTING OF PATIENTS WITH NON-SMALL CELL LUNG CANCER

Background: More than 228,000 people are diagnosed with non-small cell lung cancer (NSCLC) each year in the United States, and most die within a year. Newer targeted medications, including erlotinib and afatinib, work at a molecular level to produce profound and sustained benefit for a small percentage of patients. Specific genetic mutations, including changes in the EGFR gene, identify individuals more likely to respond to targeted therapies. Published literature shows that using results of EGFR testing to guide treatment decisions results in significantly better treatment outcomes. Mutation testing is done routinely at most academic medical centers and cancer centers; however, use in community settings is highly variable and significantly less common. Reasons for the disparity in testing rates are unknown. Methods: Twenty-three key informant interviews were conducted with community oncologists practicing in southeastern states to identify facilitators and barriers to use of EGFR testing in community settings. Results: Two characteristics predicted an increased likelihood of EGFR testing of patients with advanced or metastatic NSCLC, including less time passed since completion of oncology training, and treating a higher number of patients with NSCLC each month. The most frequently mentioned facilitator was clinical literature and treatment guidelines. The most commonly cited barriers to testing included patient-related reasons, such as patient health and unwillingness to be tested, and oncologist-specific reasons. Eight-seven percent of oncologists who reported testing some or none of their patients expressed confidence in their abilities to make optimal treatment decisions based on clinical judgment and experience instead of relying on test results. Conclusions: This study suggests there is much work to be done to increase use of EGFR testing by oncologists practicing in community settings. The first step involves convening a task force with representatives from a variety of constituencies that will develop and implement an integrated communications plan focusing on three audiences--community oncologists, other healthcare professionals, and patients, families, caregivers, and advocates located in North Carolina. Each tactic will be measured and evaluated after completion based on pre-established objectives. Regional and national expansion of the communications plan will be based on the results of the North Carolina pilot.Doctor of Public Healt