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VA oncologists’ attitudes and behaviors regarding genomic-based targeted therapy for the management of advanced lung cancer
Arney J, Helm A, Chen GJ, Hayes TG. VA oncologists’ attitudes and behaviors regarding genomic-based targeted therapy for the management of advanced lung cancer. [Abstract]. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016 Jun 3; 34(suppl):abstr e20573.
Background: Genomic-based targeted therapy (GBTT) has emerged as a treatment option for patients with advanced lung cancer. Clinical practice guidelines of the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) recommend testing all metastatic adenocarcinomas for EGFR mutation, and use of EGFR-TKIs (erlotinib) as first-line therapy for advanced adenocarcinoma lung cancer patients with EGFR mutation positive. Little is known about how oncologists utilize genomic testing and GBTT in a clinical setting. Drawing from the Cabana, et al. theoretical framework on providers' adherence to guidelines, this study aims to elicit provider and facility-level barriers and facilitators to using GBTT in VA healthcare delivery system. Methods: We conducted 25 in-depth, qualitative interviews from a sample of VA oncologists from March, 2015 and January 2016. Consistent with the Cabana, et al. framework, interviews sought to elicit oncologists' knowledge, attitudes, and intent to use GBTT, and barriers and facilitators for practicing GBTT in a VA-setting. Analysis was dictated by thematic saturation. Results: We identified varying degrees of guideline-consistent utilization of genomic testing and GBTT. Oncologists estimated that roughly 20-90% of metastatic adenocarcinomas are tested for a mutation. Many participants had never found a positive mutation and had never used GBTT in a first-line setting. Almost all participants had used GBTT in a second-line setting or as maintenance. Consistent with the Cabana et al. framework, nonadherence to guidelines seems to result from oncologists' lack of familiarity with guidelines and some barriers, including patient factors, facility resources, and organizational constraints. Conclusions: This is the first study to examine oncologists' knowledge, attitudes, and experiences with using GBTT in a clinical setting. Findings reveal a need for provider education on genomic testing and treatment guidelines. Further research is needed to fully understand how facility resources-specifically, budgetary issues in the pathology department-shape oncologists' ability to adhere to testing guidelines.