Improving Time to Molecular Testing Results in Patients With Newly Diagnosed, Metastatic Non–Small-Cell Lung Cancer

Abstract

PURPOSE: Next-generation sequencing (NGS) is a crucial component of evaluation of patients with newly diagnosed metastatic non–small-cell lung cancer (NSCLC) to determine appropriate first-line treatment. This quality improvement project aimed to reduce time to NGS results in patients with metastatic NSCLC. METHODS: We reviewed electronic medical records of patients with newly diagnosed, untreated metastatic NSCLC from December 2018 to August 2021 and determined the number of days from pathologic diagnosis to NGS results. We reviewed process maps for oncology, pathology, the Division of Research, and a NGS vendor to determine factors leading to preventable delays. Since November 2020, we created an automated, electronic weekly report to provide earlier identification of new pathologic diagnoses in patients with metastatic NSCLC. On June 2021, we worked with our NGS vendors to expand days of the week to accept specimens. RESULTS: Our interventions reduced the median time from pathologic diagnosis to NGS results from 24 (standard deviation [SD] 9) to 16 (SD 6) days. The median time from biopsy results to NGS order was reduced from 7 days to 1 day. The time from the specimen being sent from pathology to the NGS vendor was a median of 6 days in both cohorts. The total time from pathologic diagnosis to appropriate treatment was reduced from 33 (SD 18) to 22 (SD 8) days. CONCLUSION: NGS processing in a community setting can be complex. Using a systems focused approach to quality improvement is crucial in identifying the greatest barriers in an organization. We found that delays in time to NGS results can be reduced by improved communication and workflows among departments.

Fostering a High-Functioning Team in Cancer Care Using the 4R Oncology Model: Assessment in a Large Health System and a Blueprint for Other Institutions

“…Our assessment did not evaluate impact on actual care at the patient level. Such evaluation is underway, and data from three optimizations indicate positive impact, including shortening turnaround time for molecular profiling before treatment decision in lung cancer, 51 improving completion of advance care directives in breast cancer, 52 and implementing pretreatment older adult assessment and referrals. 53,54 We have not assessed intervention impact on clinical outcomes and hope to do so in the future.…”

Development of a Multilevel Model to Identify Patients at Risk for Delay in Starting Cancer Treatment

“…However, these are not a comprehensive picture of an individual’s barriers to treatment. Variables potentially affecting treatment, such as the timeliness of appropriate molecular testing, 44 were not able to be evaluated as part of the present study. Other sources of data, study populations, and variables not included here can be incorporated into future investigations to determine whether model performance can be improved.…”

Developments in predictive biomarker testing and targeted therapy in advanced stage non-small cell lung cancer and their application across European countries

“…In some countries, efforts have been made to actively improve access and overall functioning of molecular testing for NSCLC patients through dedicated projects and policies. 81 , 82 , 83 , 84 With regard to England, it should be noted that a comprehensive overview of national predictive biomarker testing rates is currently being established by the National Disease Registration Service. In the Netherlands, molecular testing results are registered nationwide in the Dutch Pathology Registry (Palga), which enables researchers to examine these reports of patients diagnosed with NSCLC within a specified time period.…”