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MA21 - Non EGFR/MET Targeted Therapies (ID 153)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Targeted Therapy
- Presentations: 1
- Now Available
MA21.03 - The International Association for the Study of Lung Cancer (IASLC) Global Survey on Molecular Testing in Lung Cancer (Now Available) (ID 1198)
14:30 - 16:00 | Author(s): Meghan Taylor
Evidence-based standards for molecular testing of lung cancer have been established, but the global frequency and practice of testing are not well understood. The IASLC conducted an international survey to evaluate current practice and barriers to molecular testing.Method
Distributed to IASLC members and other healthcare professionals, content included: 7-question introduction, 32 questions for those requesting tests/treating patients, 45 questions on performing/interpreting assays, and 24 questions on tissue acquisition. All respondents were asked to provide 3-5 barriers to implementing/offering molecular testing.
Respondents’ countries were grouped by geography or developing/developed using IASLC and World Bank criteria. Surveys were available in 7 languages. Regional comparisons used the Chi-squared test or ANOVA; free-text was analyzed with Nvivo.Result
We obtained 2,537 responses from 102 countries. Respondents were 45% Medical Oncologists, 12% Pulmonologists, 12% Thoracic Surgeons, 9% Pathologists, and 22% scientists or other. 56% of responses were from developing countries, 44% developed. Regions included: 52% Asia, 19% Europe, 11% Latin America, 11% US/Canada, 7% Other.
1683 (66%) chose the requesting/treating track (50% government, 42% academic, 8% other). 61% reported most patients in their country do not receive molecular testing, with the lowest rates in Latin America/Other (p<0.0001). 39% were not satisfied with the conditions of molecular testing in their country. Indications for requesting testing included: adenocarcinoma (89%), never-smoker (61%), female (57%), and young (54%) (variable by region, p<0.0001). 99% ordered EGFR, 95% ALK, 84% PDL1, 79% ROS1, all other tests <50%. 56% typically received results within 10 days. Only 67% were aware of CAP/IASLC/AMP guidelines, least frequently in Asia/Other (p=0.041). 37% have trouble understanding molecular testing result reports, most of whom cited a need for more technical and scientific knowledge. 75% had multidisciplinary tumor boards, but 23% met <1/month.
The 316 (12%) testing track respondents were from laboratories that were 49% academic, 35% government, and 16% private/other. 94% of laboratories offered EGFR, 83% ALK, 69% KRAS, 68% BRAF, 64% ROS1, 56% HER2, and others <50%; 68% tested for PDL1. 57% offered Multiplex assays, less frequently in Latin America/Asia (p=0.0294). 69% tested blood-derived DNA, less frequently in US/Canada/Other (0.0013). 23% of respondents reported >10% of cases are rejected due to inadequate samples; however, 47% stated there is no policy or strategy to improve the quality of the tissue samples in their country. 52% reported patients/physicians are not satisfied with the state of molecular testing in their country. Respondents performing/interpreting assays (334, 14%) were typically informed of biopsy results (91%), and notified when the sample was inadequate (84%).
The most frequent barrier to molecular testing in every region was cost, followed by quality/standards, turnaround-time, access, and awareness. After cost, time was the most common barrier in developed countries, while it was quality in developing countries. The second largest barrier was quality in Asia, access in Europe/Latin America/Other, and turn-around time in US/Canada.Conclusion
These preliminary analyses show molecular testing usage varies across the globe. Barriers vary by region, and one-third of respondents were unaware of evidence-based guidelines. Global and regional strategies should be developed to address barriers.
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
P1.16-38 - Racial Disparities in Long-Term Survival After Surgical Resection in the US (Now Available) (ID 1968)
09:45 - 18:00 | Presenting Author(s): Meghan Taylor
Racial disparities exist in US lung cancer care, including delayed access, lower use of invasive procedures such as curative-intent surgery, and worse surgical outcomes in African-Americans compared to Caucasians. We investigated if racial disparities persist in non-small cell lung cancer (NSCLC) patients who received curative-intent resection in a population-based cohort.
We examined all patients from a prospective population-based cohort who underwent curative-intent resections for lung cancer from 12 hospitals across 7 healthcare systems from 2009-2018. We compared overall survival (OS) by race and adjusted for age, sex, smoking status, family history, tumor histology, and clinical stage. We used Chi-square tests, Kaplan-Meier plots, and Cox proportional hazards modeling, reporting unadjusted and adjusted hazard ratios (aHR) with 95% confidence intervals.Result
Of the 3,418 patients, 78% were Caucasian, 22% were African-American; 42% had Medicare,15% Medicaid, 39% commercial insurance, and 3% were uninsured. Caucasians were older (mean age 67.8 vs. 64.1; p=<0.0001). African-Americans were more likely to be active smokers (p=0.0017), have adenocarcinoma histology (p=0.0167), and less likely to be clinical stage I (p=0.0453). Median follow-up time in censored patients was 3.4 years. Overall, we found no differences in OS by race (unadjusted HR: 0.97 [0.88-1.08]; aHR: 0.998 [0.87-1.15]). However, stratified by insurance, we found significant differences (p=0.0251). Among patients with Medicaid insurance, African-Americans had significantly better OS (aHR: 0.73 [0.55-0.97]) than Caucasians but among patients with commercial insurance, African-Americans had significantly worse OS (aHR: 1.26 [1.02-1.57]).
When all patients receive curative-intent surgical resection, racial disparities in NSCLC survival may be reduced, but differences in the impact of race on survival by type of insurance suggest residual and complex disparities in both access and quality of care. Further exploration of the interaction between race, socio-economic factors, and the mechanisms of lung cancer outcome disparities is warranted.