Barriers, facilitators, and practice patterns for next-generation sequencing testing use for non-small cell lung cancer patients.

Abstract

e23246 Background: Next-generation sequencing (NGS) testing is used to identify driver mutations to guide selection of therapy in early-stage and metastatic non-small cell lung cancer (NSCLC). However, uptake into oncology practice has varied. The objective of this study was to identify practice patterns and barriers to NGS testing. Methods: We conducted a convergent mixed-methods analysis of oncology clinicians/stakeholders across 10 academic and community hospitals participating in a statewide cancer quality improvement (QI) collaborative. We distributed a survey asking about local practice patterns around NGS testing. We conducted semi-structured focus groups/interviews of oncology clinicians, asking about barriers to NGS use, which were analyzed using thematic analysis. We triangulated the data to develop a QI toolkit bundle. Results: A total of 45 survey responses and 17 focus groups/interviews of 37 participants were collected. Among the 10 participating hospitals, 5 (50.0%) hospitals used reflex testing protocols, 3 (30.0%) had in-house molecular labs, and 3 (30.0%) had both reflex testing protocols and in-house molecular labs. From survey responses, 40% of medical oncologists reported not having NGS results available at the time of consultation at least 50% of the time. Barriers to NGS testing included the need for repeat tissue sampling due to insufficient specimen yields, long turnaround times of NGS results leading to treatment decisions being made prior to having NGS results, and fragmented coordination of tissue specimen acquisition or NGS results from outside facilities. Facilitators to NGS testing included use of concurrent liquid biopsy, integration of results into the electronic health record, rapid onsite evaluation (ROSE) to assess tissue adequacy, and use of reflex NGS testing protocols. For early-stage NSCLC patients, barriers to NGS testing included varied clinical stage indications for performing NGS testing (eg: stage-agnostic versus only locally advanced patients) as well as non-standardized use of molecular testing platforms due to insurance or clinician preference. Process measures, such as quantity not sufficient (QNS) rates, were often not known by proceduralists or pathologists. Domains of resources highlighted in the QI toolkit bundle include guidance on patient selection for NGS testing, best practices on tissue collection protocols to reduce need to re-biopsy, guidance on clinical data intake, and guidance on prospective data collection for process improvement. Conclusions: In a statewide QI collaborative, hospital-level variation exists in NGS testing due to non-standardized and decentralized diagnostic testing processes and lack of clinical data collection for appropriate process improvement. These data informed development of a QI toolkit bundle used for locally tailored QI interventions.