EMBER-Lung: Electronic Medical Record Boosting Molecular Testing in Early-Stage Non-Small Cell Lung Cancer.

Area of Science:

• Oncology
• Clinical Informatics
• Genomics

Background:

• Adjuvant targeted therapies and perioperative chemoimmunotherapy necessitate molecular testing in early-stage nonsquamous (NSq) non-small cell lung cancer (NSCLC).
• Timely and comprehensive molecular testing (cMT) is crucial for guiding treatment decisions in NSCLC.

Purpose of the Study:

• To evaluate an electronic medical record (EMR)-based nudge intervention designed to increase the completion rate of cMT.
• To assess the impact of the nudge on detecting actionable molecular alterations in early-stage NSq NSCLC.

Main Methods:

• Prospective enrollment of patients undergoing surgical resection in the EMBER-Lung trial.
• Implementation of an EMR-based nudge post-surgery to prompt cMT orders for NSq NSCLC.
• Comparison of cMT completion rates and molecular findings between nudge intervention and control cohorts.

Main Results:

• The nudge intervention significantly increased cMT completion from 36.9% to 81.1% (P < .00001).
• A higher proportion of patients in the nudge group had detectable EGFR mutations (16.9% vs 6.5%) and KRAS G12C mutations (13.6% vs 5.5%).
• The intervention demonstrated feasibility across all stages (I-III) of early-stage NSq NSCLC.

Conclusions:

• An EMR-based nudge is a feasible and effective strategy to enhance cMT completion in early-stage NSq NSCLC post-resection.
• This approach can improve the identification of targetable mutations, potentially optimizing patient care.
• Future research aims to implement this nudge earlier in the diagnostic pathway, at the time of biopsy, to inform neoadjuvant therapy.