Understanding Factors Associated With Anaplastic Lymphoma Kinase Testing Delays in Patients With Non-Small Cell Lung...

Area of Science:

• Oncology
• Clinical Pathology
• Health Services Research

Background:

• Timely therapeutic decisions are critical for advanced non-small cell lung cancer (NSCLC) patients due to multiple treatment options.
• Anaplastic lymphoma kinase (ALK) testing is essential for identifying patients eligible for targeted therapies.

Purpose of the Study:

• To evaluate factors influencing the ordering of ALK tests and the time taken for result delivery in advanced NSCLC.
• To identify bottlenecks in the ALK testing process within US community practices.

Main Methods:

• Retrospective analysis of 14,657 ALK tests from 14,197 advanced NSCLC patients (Jan 2015-May 2019).
• Data extracted from a de-identified electronic health record database.
• Multivariable logistic regression used to identify factors associated with delayed test ordering ( >20 days) and turnaround time ( >10 days).

Main Results:

• Median ALK test order time was 15 days, with 36.4% of orders delayed.
• Factors associated with order delays included non-fluorescence in situ hybridization (FISH) testing, send-out labs, pre-2018 testing, non-adenocarcinoma histology, and smoking history.
• Median turnaround time was 9 days, with 40.3% of results delayed. Non-FISH testing, tissue samples, and combined biomarker orders were linked to reporting delays.

Conclusions:

• Real-world data reveals significant delays in both ALK test ordering and result reporting in US community practices.
• Multiple factors contribute to these delays, highlighting areas for process improvement.
• Optimizing ALK testing turnaround is imperative for timely patient identification for targeted therapy.