Real-world findings from a multi-institutional quality study using CFIR to explore gaps, challenges, and opportunities around implementing precision medicine in community cancer settings.

Abstract

e23157 Background: Precision medicine holds promise for improving cancer care, yet significant challenges persist in implementing multigene NGS testing and incorporating targeted therapies in community cancer settings. To better understand these issues, an implementation science framework was used to identify key barriers and facilitators to inform future QI projects. Methods: The study involved a retrospective review of cancer biomarker testing patterns across three community cancer centers, coupled with stakeholder interviews and process mapping to understand barriers and facilitators. Data collection and analysis were guided by the CFIR (Consolidated Framework for Implementation Research) to assess gaps in NGS testing patterns, delays in testing, and medical treatment plans. Results: Key findings across the centers included delays in biomarker testing ( > 4 weeks from diagnosis) in 43% of patients with lung cancer and in 68% of patients with other solid tumors. 33% of patients with NSCLC received liquid biopsy testing. 14% of patients with NSCLC were treated with immunotherapy prior to testing. The CFIR domains and constructs revealed the following barriers in NGS testing: • Outer Setting: Insurance may not cover both tissue and plasma testing. Medicare 14-day rule may delay testing in hospitalized patients. • Inner Setting: Lack of organizational policies to govern NGS testing. Limited in-house testing capabilities. Suboptimal communication between oncologists and pathologists when tests are ordered. Lack of computerized order entry for NGS testing when sending out to reference labs. Missed opportunities to discuss patient cases and NGS testing at tumor board. • Individuals: Varying perspectives among clinicians regarding who should receive testing and when tests should be ordered. Need for education about actionable genomic alterations for specific tumors and the role of targeted therapies. Personal bias to use standard chemotherapy or immunotherapy over targeted therapies. Facilitators included strong clinical leadership promoting NGS testing, multidisciplinary collaboration with pathology, and consensus on using one reference lab for send-out testing. Conclusions: This quality study highlights key implementation barriers and facilitators affecting cancer biomarker testing and targeted therapy. These findings can guide other cancer centers in developing and implementing interventions to improve precision medicine delivery and optimize patient outcomes. Future work will assess the impact of targeted QI interventions aimed at key implementation drivers. Time from initial diagnosis to biomarker results. Lung cancer (n=51) Other solid tumors (n=68) Biomarker results < 4 weeks after diagnosis 57% 32% Results in 4 to 8 weeks 22% 12% Results > 8 weeks 22% 56%