Mixed Methods Evaluation of Gaps and Barriers in Delivery of Precision Oncology in Advanced Lung Cancer

Lung cancer is the leading cause of cancer mortality and has well described disparities in outcomes. Significant survival gains in non-small cell lung cancer (NSCLC) have been achieved due to precision oncology, however, shortfalls in its delivery will further exacerbate disparities. Patient navigation is an approach to address cancer care disparities. We sought to characterize the barriers and facilitators to precision oncology through a mixed methods approach.

We performed a cross-sectional study of patient navigators, pathologists, and clinicians in North Carolina (NC). We conducted surveys and interviews to assess barriers and facilitators to effective delivery of precision medicine for patients with advanced NSCLC, including next generation sequencing (NGS) and use of targeted therapies and immunotherapy. We recruited both community-based and academic cancer providers across the state.

Fifty-six participants completed the survey, with representation from both community and academic sites, and five completed interviews. Clinicians reported gaps in delivery of precision medicine as well as knowledge gaps, feeling "not at all" or "a little bit" knowledgeable about NGS (19%), liquid biopsy (32%) and targeted therapies (19%). Navigators endorsed common conversations about precision medicine but felt "somewhat" or "very" uncomfortable discussing NGS (38%), targeted therapies (31%), and limited confidence in resolving barriers. Qualitative interviews highlighted potential solutions including financial aid, dedicated pathology support, use of liquid biopsy, and partnership with social work.

Academic and community-based clinicians in N.C. reported gaps in delivery of precision oncology in advanced NSCLC. Navigators reported a significant role in precision oncology education and delivery but limited confidence in doing so. Qualitative data highlight potential strategies for improving access. These findings suggest a need for further interventions and education to support clinicians and navigators disseminating precision oncology.