Recent advances in cancer genomics and targeted therapies have changed the treatment landscape for lung cancer, but disparities in access to precision medicine remain, according to data presented during the International Association for the Study of Lung Cancer (IASLC) 2021 World Conference on Lung Cancer.¹

Results of the survey of oncology clinicians based in the United States showed that less than half of community oncologists use biomarker testing to guide patient discussions, compared with 73% of academic clinicians (P = .021).¹ Moreover, just 40% of respondents were “very” or “extremely familiar” with the 2018 molecular testing guidelines for lung cancer from the College of American Pathologists (CAP), IASLC, and the Association for Molecular Pathology (AMP).²

Leigh M. Boehmer, PharmD, BCOP

“This study identifies key areas of ongoing clinician need related to biomarker testing, including increased guideline familiarity, practical applications of guideline-concordant testing, and how to optimally help coordinate multidisciplinary care,” said lead study author Leigh M. Boehmer, PharmD, BCOP, Chief Medical Officer of the Association of Community Cancer Centers (ACCC). “Professional organizations and advocacy groups should focus on developing impactful education materials and tools for improving patient-clinician discussions about biomarker testing.”

Despite the recent advances in precision oncology, Dr. Boehmer expressed concern that these new methods, which include biomarker testing, will not be used equally throughout the health-care system and could even worsen existing disparities.

According to Dr. Boehmer, many variables contribute to disparities in biomarker testing, including access to quality health care, environmental factors, potential mistrust in various health-care systems, and the degree to which select patients and clinicians comprehend the importance of biomarker testing relative to treatment planning. “Sadly, we have an epidemic of imprecise access to precision medicine,” Dr. Boehmer said. “This is due, in part, to the limited understanding of the etiology and genetics of cancer, especially within certain underserved racial and ethnic patient populations.”

Survey Creation

To better understand current practice patterns and attitudes toward biomarker testing, Dr. Boehmer and colleagues developed a clinician-facing survey instrument with an expert panel convened by ACCC. The survey instrument was based on data analysis, open-ended response coding, and subanalyses between demographic cohorts (with an emphasis on community vs academic clinicians) to capture differences in decision-making and attitudes expressed, Dr. Boehmer reported.

“Professional organizations and advocacy groups should focus on developing impactful education materials and tools for improving patient-clinician discussions about biomarker testing.”

— Leigh M. Boehmer, PharmD, BCOP

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The researchers distributed survey invitations by e-mail between June and August 2020 to a random sample of ACCC member oncology clinicians. Clinicians who had cared for patients with non–small cell lung cancer who were insured by Medicaid or uninsured were included in the study. Survey results were further validated via two focus groups using a standard facilitation guide.

Lack of Shared Decision-Making Among Community Oncologists

Of the 99 responses gathered, 68% of respondents practiced in a community setting, whereas the remaining 32% practiced in an academic setting.

As Dr. Boehmer reported, just 40% of responding physicians indicated they were “very” or “extremely familiar” with the 2018 CAP/IASLC/AMP molecular testing guidelines for lung cancer. When asked about their confidence in areas related to biomarker testing, 40% of respondents indicated they were least confident in “coordinating care across the multidisciplinary team as part of testing,” and 35% expressed doubts about “determining when to order testing.”

“Issues with coordinating care and lack of communication were echoed in our focus groups,” said Dr. Boehmer. “For instance, one medical oncologist in an urban hospital setting desired reflex testing but had to ask the radiologist or pathologist to initiate testing on a case-by-case basis.”

Additional findings from the survey showed that clinicians are most likely to order biomarker testing to make targeted treatment decisions. However, academic clinicians (73%) were far more likely than their community peers (48%) to use these results to inform discussions with patients about disease prognosis.

This attitude toward biomarker testing was also reflected in responses concerning shared decision-making. Although 41% of clinicians prefer to share responsibility about testing with their patients, said Dr. Boehmer, 52% prefer to make the final decision themselves.

“Focus group participants noted that they felt patients lacked comprehension and interest about what testing entails and what testing means for their treatment options,” Dr. Boehmer said. “Oncologists said they don’t want to confuse [their patients] and add to their problems.”

Finally, survey respondents indicated the need for “more information on financial resources” as well as education around both published guidelines and practical implications of clinical data to make more informed decisions about biomarker testing. ACCC is currently developing an intervention based on a validated care sequence tool to ensure that discussions about biomarker testing are easily integrated into the care process for every patient, Dr. Boehmer concluded. 

DISCLOSURE: Dr. Boehmer has served as a consultant for Pfizer.

REFERENCES

1. Boehmer L, Roy UB, Schrag J, et al: Perceptions of biomarker testing for underserved patients with lung cancer: A mixed-methods survey of US-based oncology clinicians. 2021 World Conference on Lung Cancer. Abstract OA10.01. Presented September 9, 2021.

2. Lindeman NI, Cagle PT, Aisner DL, et al: Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: Guideline from the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. Arch Pathol Lab Med 142:321-346, 2018.