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Survey reveals ‘suboptimal awareness’ of lung cancer molecular testing guidelines
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BARCELONA — One-third of health care professionals reported a lack of knowledge about evidence-based guidelines for molecular testing of lung cancer, according to survey results presented at International Association for the Study of Lung Cancer World Conference on Lung Cancer.
Although there are evidence-based standards for molecular testing of lung cancer, the global frequency and practice of testing had not been well understood.
"We’ve talked about significant advances made in lung cancer, and a lot of that has to do with targeted therapies. Molecular testing is a key component to finding the right treatment,” Matthew Smeltzer, PhD, assistant professor in the division of epidemiology, biostatistics and environmental health at the University of Memphis School of Public Health, said during a press conference. “With that in mind, we designed an international survey to evaluate how physicians feel we are doing with molecular testing.”
Smeltzer and colleagues administered a survey — which consisted of a seven-question introduction, 32 questions for those requesting tests/treating patients, 45 questions on performing/interpreting assays, and 24 questions on tissue acquisition — electronically in a variety of languages to International Association for the Study of Lung Cancer (IASLC) members and other health care professionals worldwide.
Researchers received 2,537 responses from medical oncologists (45%), pulmonologists (12%), thoracic surgeons (12%), pathologists (9%), and scientists or other health care professionals (22%). The respondents represented 102 countries, 56% of which were developing nations, and most respondents were from Asia (52%).
Survey respondents said the most common patients for whom they requested lung cancer molecular testing included those with adenocarcinoma (89%), never-smokers (61%), women (57%) and young people (54%). The most common tests requested EGFR (94%), ALK (83%), KRAS (69%), BRAF (68%), ROS1 (64%) and HER2 (56%).
Sixty-one percent of respondents predicted that most patients in their country do not receive molecular testing, with the lowest rates reported in Latin America.
Forty-one percent of respondents were not satisfied with the state of molecular testing in their country, and 17% felt patients also were unsatisfied. Specific concerns included trouble understanding testing results, time it takes to receive results and reliability of samples.
Overall barriers to molecular testing included cost, quality, access, awareness and time.
Thirty-three percent of health care professionals reported that they were not aware of the most up to date guidelines for molecular testing from College of American Pathologists/IASLC/Association for Molecular Pathology, with Asia having the lowest awareness rate.
“Overall, we’re still finding that many in the lung cancer community are not satisfied with the state of molecular testing,” Smeltzer said during the press conference. “We’ve got suboptimal awareness of evidence-based guidelines, and barriers remain.”
In an interview with HemOnc Today, Smeltzer said he was surprised by the extent of the knowledge gap regarding molecular testing.
“I would not have been surprised to find suboptimal adherence to evidence-based guidelines in some regions,” he said, “but I was surprised to find such a high percentage who were not aware the guidelines exist.”
He added that the clear lack of satisfaction among clinicians about the state of molecular testing is an important priority that is currently being addressed.
“The IASLC community has shown great interest in understanding these results and using them to improve care for patients with lung cancer,” he told HemOnc Today. “We are working together to develop updated strategies to promote evidence-based molecular testing for lung cancer.” – by Jennifer Byrne
Reference:
Smeltzer M, et al. Abstract MA21.03. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer; Sept 7-10, 2019; Barcelona.
Disclosures: AstraZeneca funded the survey. Smeltzer reports research funding from Bristol-Myers Squibb Foundation. Please see the abstract for all other authors’ relevant financial disclosures.