Authors
J. Dow, N. Zimmerman, S. Monzon, W. Zhao, A. Barrett, V. Erese, C. Gurbatri, E. Cohen, C. ScottoDiVetta, I. Huerga, H. Nimeiri, D.H. Owen, J.D. Patel
Introduction: Approvals of targeted therapies have rapidly increased over the past decade, leading to complex and frequently updated clinical guidelines. This trend has contributed to pervasive gaps in NCCN guideline-directed care. Here we report a care pathway analysis to characterize NCCN-recommended molecular testing rates in early stage NSCLC (eNSCLC).
Methods: The study analyzed de-identified data from Tempus’ nationwide longitudinal electronic health records database, focusing on 18-89 year-old patients newly diagnosed with lung cancer in 2022. Patients were randomly sampled for abstraction of >120 data elements from their unstructured clinical documents, including progress notes, pathology reports, discharge summaries, and genomic testing results. 913 patients (289,317 unstructured clinical documents) across 4 community practices in the US were included. Curated data were independently reviewed by an oncologist and clinical data director and cross checked against ML/AI predictions to ensure data quality.
Results: 39 non-squamous, resected NSCLC patients with pathologic stage IB-IIIB [T3, N2] (n=39) were identified as qualifying for EGFR testing according to 2022 NCCN NSCLC Guidelines. 13/39 (33%) of these patients did not receive molecular testing for EGFR mutation. 10/13 (77%) untested patients had an actionable biomarker testing care gap (e.g. negative nodes or margins after surgery, no specified reason). 3/13 untested patients had no actionable biomarker testing care gap (e.g. unresectable via surgical attempt, patient refused treatment).
Of 26 EGFR tested patients, 22 (85%) patients received testing prior to adjuvant treatment to inform therapy selection. 4/26 (15%) of these patients harbored an actionable EGFR mutation. Patient demographics and insurance type were analyzed as possible explanations for care gaps.
Conclusions: This analysis revealed a significant care gap in eNSCLC patients receiving EGFR molecular testing, which is necessary for adjuvant TKI therapy eligibility per NCCN guidelines. Addressing this gap through healthcare interventions, such as care pathway automation tools, could improve adherence to guidelines, ultimately enhancing patient outcomes.
Table 1: Site level eNSCLC cohort attrition & EGFR testing rate
|
Site 1 N |
Site 1 % of previous |
Site 2 N |
Site 2 % of previous |
Site 3 N |
Site 3 % of previous |
Site 4 N |
Site 4
% of previous |
Total N |
Total % of previous |
| Total new lung diagnoses in 2022 |
403 |
|
810 |
|
342 |
|
128 |
|
1,683 |
|
| Sampled for analysis |
354 |
(88) |
270 |
(33) |
197 |
(58) |
92 |
(72) |
913 |
(54) |
| Primary NSCLC diagnosis |
230 |
(65) |
125 |
(46) |
140 |
(71) |
55 |
(60) |
550 |
(60) |
| No evidence of being in clinical trial |
230 |
(100) |
124 |
(99) |
140 |
(100) |
55 |
(100) |
549 |
(100) |
| Available staging data |
206 |
(88) |
92 |
(74) |
89 |
(64) |
53 |
(96) |
440 |
(80) |
| Early stage [Stage IB-IIIB] |
61 |
(30) |
21 |
(23) |
25 |
(28) |
18 |
(34) |
125 |
(28) |
| Non-squamous |
40 |
(66) |
11 |
(52) |
19 |
(76) |
8 |
(44) |
78 |
(62) |
| Resected |
22 |
(66) |
4 |
(36) |
11 |
(53) |
2 |
(25) |
39 |
(50) |
| EGFR tested |
15 |
(68) |
3 |
(75) |
8 |
(73) |
0 |
(0) |
26 |
(67) |
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