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Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Practice-Level Variation in Molecular Testing and Use of Targeted Therapy for Patients With Non-Small Cell Lung
Thomas J Roberts1,2, Kenneth L Kehl1, Gabriel A Brooks3
1Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
Importance:
All patients with newly diagnosed non-small cell lung cancer (NSCLC) and colorectal cancer (CRC) should receive molecular testing to identify those who can benefit from targeted therapies. However, many patients do not receive recommended testing and targeted therapies.
Objective:
To compare rates of molecular testing and targeted therapy use by practice type and across practices.
Design, Setting, And Participants:
This cross-sectional study used 100% Medicare fee-for-service data from 2015 through 2019 to identify beneficiaries with new metastatic NSCLC or CRC diagnoses receiving systemic therapy and to assign patients to oncology practices. Hierarchical linear models were used to characterize variation by practice type and across practices. Data analysis was conducted from June 2019 to October 2022.
Exposures:
Oncology practice providing care.
Outcomes:
Primary outcomes were rates of molecular testing and targeted therapy use for patients with NSCLC and CRC. Secondary outcomes were rates of multigene testing for NSCLC and CRC.
Results:
There were 106 228 Medicare beneficiaries with incident NSCLC (31 521 [29.7%] aged 65-69 years; 50 348 [47.4%] female patients; 2269 [2.1%] Asian, 8282 [7.8%] Black, and 91 215 [85.9%] White patients) and 39 512 beneficiaries with incident CRC (14 045 [35.5%] aged 65-69 years; 17 518 [44.3%] female patients; 896 [2.3%] Asian, 3521 [8.9%] Black, and 32 753 [82.9%] White patients) between 2015 and 2019. Among these beneficiaries, 18 435 (12.9%) were treated at National Cancer Institute (NCI)-designated centers, 8187 (5.6%) were treated at other academic centers, and 94 329 (64.7%) were treated at independent oncology practices. Molecular testing rates increased from 74% to 85% for NSCLC and 45% to 65% for CRC. First-line targeted therapy use decreased from 12% to 8% among patients with NSCLC and was constant at 5% for patients with CRC. For NSCLC, molecular testing rates were similar across practice types while rates of multigene panel use (13.2%) and targeted therapy use (16.6%) were highest at NCI-designated cancer centers. For CRC, molecular testing rates were 3.8 (95% CI: 1.2-6.5), 3.3 (95% CI, 0.4-6.1), and 12.2 (95% CI, 9.1-15.3) percentage points lower at hospital-owned practices, large independent practices, and small independent practices, respectively. Rates of targeted therapy use for CRC were similar across practice types. After adjusting for patient characteristics, there was moderate variation in molecular testing and targeted therapy use across oncology practices.
Conclusions And Relevance:
In this cross-sectional study of Medicare beneficiaries, molecular testing rates for NSCLC and CRC increased in recent years but remained lower than recommended levels. Rates of targeted therapy use decreased for NSCLC and remained stable for CRC. Variation across practices suggests that where a patient was treated may have affected access to recommended testing and efficacious treatments.
Insights
Molecular testing for non-small cell lung cancer (NSCLC) and colorectal cancer (CRC) increased but remains below recommended levels. Targeted therapy use decreased for NSCLC and stayed stable for CRC, with practice type influencing access.
Area of Science:
- Oncology
- Cancer Research
- Health Services Research
Background:
- Molecular testing is crucial for identifying patients with non-small cell lung cancer (NSCLC) and colorectal cancer (CRC) who can benefit from targeted therapies.
- Despite recommendations, many patients do not receive timely molecular testing or subsequent targeted treatments.
Purpose of the Study:
- To compare the rates of molecular testing and targeted therapy utilization across different oncology practice types.
- To identify variations in the adoption of molecular testing and targeted therapies for NSCLC and CRC patients.
Main Methods:
- A cross-sectional study analyzing Medicare fee-for-service data from 2015-2019.
- Inclusion of beneficiaries with newly diagnosed metastatic NSCLC or CRC receiving systemic therapy.
- Hierarchical linear models used to assess practice-level variations.
Main Results:
- Molecular testing rates for NSCLC and CRC increased but remained below recommended levels.
- Targeted therapy use decreased for NSCLC and remained stable for CRC.
- Rates of multigene panel use and targeted therapy were highest at NCI-designated cancer centers for NSCLC; CRC testing varied significantly by practice type.
Conclusions:
- While molecular testing rates have improved, they have not reached optimal levels for NSCLC and CRC patients.
- Disparities in testing and treatment access exist across different oncology practice settings.
- Patient outcomes may be influenced by the type of oncology practice providing care, highlighting the need for equitable access to molecular diagnostics and targeted treatments.
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