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
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 |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2023 ASCO Annual Meeting
First Author: Gregory A. Vidal
2023 ASCO Annual Meeting
First Author: Ferdinandos Skoulidis
2023 ASCO Quality Care Symposium
First Author: Juanyi Tan
2023 ASCO Annual Meeting
First Author: Helena Bote