Defining key care events to integrate biomarker testing in the workup for patients with advanced non–small cell lung cancer (aNSCLC).

Authors

Nikki Martin

Nikki A. Martin

LUNGevity Foundation, Bethesda, MD

Nikki A. Martin, Latha Shivakumar, Leigh Boehmer, Ashley Lile, Stephanie A. Cohen, Amy Jo Pixley, Elana Plotkin, Julia R. Trosman, Christine B. Weldon

Organizations

LUNGevity Foundation, Bethesda, MD, Association of Community Cancer Centers, Rockville, MD, Ascension St. Vincent, Indianapolis, IN, Penn Medicine Lancaster General Health Ann B. Barshinger Cancer Institute, Lancaster, PA, Center for Business Models in Healthcare, Chicago, IL, Northwestern University Feinberg School of Medicine, Chicago, IL

Research Funding

Other Foundation
LUNGevity.

Background: Biomarker testing is critical in management of aNSCLC, but timely testing for newly diagnosed patients is challenging. Clinician and patient perspectives on barriers to timely biomarker testing for patients with health disparities have been reported (Boehmer et al 2021, 2022; Martin et al 2022). To address barriers, we are developing a novel intervention to integrate biomarker testing into aNSCLC workup using the 4R Oncology Model (Trosman et al 2016, 2021). The intervention facilitates timing and sequencing of key care events enabling biomarker testing as well as incorporating clinician and patient perspectives. We report care events which form the foundation of the intervention. Methods: We conducted focus groups with 12 clinicians at 3 Association of Community Cancer Centers (ACCC) member programs. Each clinician treats patients with NSCLC and socioeconomic and/or health disparities. Results: We identified 5 key care events facilitating biomarker testing that should be integrated into workup for patients newly diagnosed with aNSCLC (Table). For each event, we defined dependency to enable timing and sequencing of care and considerations for clinicians and patients. Conclusions: The 5 key care events, dependencies, and clinician and patient considerations represent a basis for incorporating biomarker testing into the aNSCLC workup that is both patient and clinician centric. Implementation and evaluation of the 4R Oncology model incorporating the 5 key care events are underway at 3 cancer centers.

Key Care Event
Dependency on other care events
Important factors
Clinician considerations
Patient considerations
1. Tissue diagnosis
Abnormality on chest x-ray or CT scan, or other lung abnormality
-
Patient’s ability to have a biopsy due to contraindications
Stop use of prescription blood thinners, aspirin. Cost sharing of workup
2. Pathology Confirmation
Biopsy tissue
Ability to locate tumor; confidence in whether enough heterogeneity of tissue was captured for adequate tissue quality and quantity
-
-
3. Imaging: PET, CT, Brain MRI, other
Biopsy tissue analyzed and NSCLC diagnosed

Consider ordering biomarkers if delay in imaging
Cost sharing of imaging
4. Biomarker test order
Imaging results to determine stage
Internal processes: who orders test, where biopsy sample is stored
Type of test to order: NGS vs hotspot; tissue and/or plasma. Convey to patient the need to wait for results if indicated
Cost sharing of biomarker testing; Health maintenance, supportive care while waiting for results
5. Determine treatment plan based on biomarker test results
Comprehensive biomarker test results: NGS, PD-L1
Assessment of patient co-morbidities, ECOG status, imaging results
Discuss biomarker test results and treatment selection with the patient;

clinical trials relevant for patient
Whether actionable biomarker was identified, treatment options, cost of treatment

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Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Quality Improvement Research and Implementation Science

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 346)

DOI

10.1200/JCO.2022.40.28_suppl.346

Abstract #

346

Poster Bd #

D19

Abstract Disclosures

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