Challenges in implementation of molecular classification in early stage endometrial cancer-An NRG Oncology cooperative group mixed-methods study

Elise M Wilson ^1,2, Ruizhi Huang ³, Kristen D Jones ¹

⁰Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, Missouri, USA.

Cancer +

|

October 18, 2024

View abstract on PubMed

Summary

Molecular profiling for mismatch repair (MMR), p53, and polymerase epsilon (POLE) is recommended for endometrial cancer (EC). However, significant barriers, including cost and access, hinder widespread adoption in clinical practice.

Area Of Science

Oncology
Molecular Diagnostics
Implementation Science

Background

Professional guidelines advocate for molecular profiling (MMR, p53, POLE) in endometrial cancer (EC).
Current adoption rates and implementation barriers in the US remain undocumented.

Purpose Of The Study

To document the adoption of molecular profiling for EC in the US.
To identify barriers to implementing MMR, p53, and POLE testing.

Main Methods

A mixed-methods study utilizing implementation science frameworks.
Quantitative survey distributed to oncologists and pathologists affiliated with NRG Oncology programs (2022-2023).
Qualitative interviews with a subset of survey respondents, followed by statistical and thematic analyses.

Main Results

Over 90% of respondents deemed POLE, MMR, and p53 status crucial for EC care.
While MMR and p53 tests were accessible, POLE testing posed challenges for 75.8% of respondents.
Academic sites reported superior access and perceived importance of molecular classification compared to community sites.
Cost was a major barrier, and desire for prospective data to guide treatment was expressed.

Conclusions

Despite clinician agreement on the importance of molecular profiling for early-stage EC, significant implementation barriers exist.
Disparities in implementation challenges were noted between academic and community oncology settings.
Equitable access strategies for molecular classification of early-stage EC are essential.

Keywords:

NRG Oncology endometrial cancer mixed methods molecular profiling pathology