Advancing evidence-based NSCLC testing and treatment across academic and community-based settings.

Abstract

8621 Background: Comprehensive testing for guideline-recommended driver mutations in advanced non-small cell lung cancer (aNSCLC) remains underutilized. Methods: From Feb to Mar 2024, 20 healthcare professionals (HCPs) were surveyed from one academic and one community-based oncology system in the same region and retrospective chart audits (N=100) were performed to assess current practices, challenges/barriers, and areas for improvement in biomarker testing and use of targeted therapies in aNSCLC. Based on these baseline findings, an expert steering committee, including an oncologist, pathologist, surgeon, and site representatives, developed a NSCLC biomarker toolkit to support evidence-based testing. Clinical teams reviewed the data in audit feedback sessions and developed and implemented action plans to address identified gaps. Results: Both academic and community HCPs (aHCPs, cHCPs; 60%) cited determining the appropriate molecular tests to order for treatment decisions as their top challenge in integrating targeted therapies into practice. Significant variation was reported in which team member checks insurance authorization for molecular testing and submits the order, and how the medical oncologist is notified when test results are available. Most HCPs (93%) said molecular test results are not consistently scanned into the same chart locations. Compared to aHCPs, cHCPs were more likely to start NSCLC treatment before receiving molecular test results and reported significantly lower confidence in shared decision-making with pts. Top challenges in adverse event (AE) management were patient communication about recognizing AEs for aHCPS (80%), and staying updated on AEs from targeted therapies (50%) for cHCPs. Chart audits revealed greater variability in frontline therapies prescribed to pts treated in a community setting. Molecular testing was ordered for 86% of pts overall, including 100% in academic settings and 72% in community settings; 81% of pts had a documented mutation. As a result of this initiative, systems developed action plans to integrate the biomarker testing tool into practice, improve workflows for reflex testing, standardize molecular test documentation in EMRs, and utilize AI dashboards and dedicated phone lines to streamline communication with NSCLC patients about treatments and side effects. Additional follow-up data will be presented. Conclusions: This project uncovered real-world gaps in biomarker testing and evidence-based integration of targeted therapy for aNSCLC and revealed unique differences between academic and community settings, driving action plans to improve clinical workflows and communication. The biomarker testing toolkit and sustainable process changes implemented in this QI initiative represent key opportunities for improvement that can be implemented in clinics across the country to improve NSCLC care.