Matthew P Smeltzer1, Murry W Wynes2, Sylvie Lantuejoul3, Ross Soo4, Suresh S Ramalingam5, Marileila Varella-Garcia6, Meghan Meadows Taylor7, Kristin Richeimer2, Kelsey Wood2, Kristen E Howell7, Mercedes Lilana Dalurzo8, Enriqueta Felip9, Gina Hollenbeck10, Keith Kerr11, Edward S Kim12, Clarissa Mathias13, Jose Pacheco6, Pieter Postmus14, Charles Powell15, Masahiro Tsuboi16, Ignacio I Wistuba17, Heather A Wakelee18, Chandra P Belani19, Giorgio V Scagliotti20, Fred R Hirsch21. 1. Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee. Electronic address: msmltzer@memphis.edu. 2. International Association for the Study of Lung Cancer, Aurora, Colorado. 3. Department of Biopathology, Centre Léon Bérard UNICANCER, and CRCL, Lyon and Grenoble Alpes University, Grenoble, France. 4. Department of Hematology and Oncology, National University Cancer Institute, Singapore, Singapore. 5. Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia. 6. Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Cancer Center, Aurora, Colorado. 7. Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee. 8. Department of Pathology, Hospital Italiano Buenos Aires, Buenos Aires, Argentina. 9. Lung Cancer Unit, Oncology Department, Vall d'Hebron University, Barcelona, Spain. 10. ALK Positive, Inc., Worldwide, Memphis, Tennessee. 11. Department of Pathology, Aberdeen University Medical School, Aberdeen, Scotland, United Kingdom. 12. Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina. 13. Núcleo de Oncologia da Bahia-Oncoclínicas, Salvador Bahia, Brazil. 14. Department of Pulmonology, Leiden University Medical Centre (LUMC), Leiden, Netherlands. 15. Mount Sinai-National Jewish Health Respiratory Institute, New York, New York. 16. Department of Dignostic Radiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 17. Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 18. Division of Oncology, Stanford University School of Medicine and Stanford Cancer Institute, Stanford, California. 19. Division of Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania. 20. Department of Oncology, University of Torino, Torino, Italy. 21. Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai, New York, New York.
Abstract
INTRODUCTION: Access to targeted therapies for lung cancer depends on the accurate identification of patients' biomarkers through molecular testing. The International Association for the Study of Lung Cancer (IASLC) conducted an international survey to evaluate perceptions on current practice and barriers to implementation of molecular testing. METHODS: We distributed the survey to IASLC members and other health care professionals around the world. The survey included a seven-question introduction for all respondents, who then answered according to one of three tracks: (1) requesting tests and treating patients, (2) performing and interpreting assays, or (3) tissue acquisition. Barriers to implementing molecular testing were provided in free-response fields. The chi-square test was used for regional comparisons. RESULTS: A total of 2537 respondents from 102 countries participated. Most respondents who test and treat patients believe that less than 50% of patients with lung cancer in their country receive molecular testing, but reported higher rates within their own practice. Although many results varied by region, the five most frequent barriers cited in all regions were cost, quality and standards, access, awareness, and turnaround time. Many respondents expressed dissatisfaction with the current state of molecular testing for lung cancer, including 41% of those performing and interpreting assays. Issues identified included trouble understanding results (37%) and the quality of the samples (23% reported >10% rejection rate). Despite concerns regarding the quality of testing, 47% in the performing and interpreting track stated there is no policy or strategy to improve quality in their country. In addition, 33% of respondents who request tests and treat patients were unaware of the most recent College of American Pathologists, IASLC, and Association for Molecular Pathology guidelines for molecular testing. CONCLUSIONS: Adoption of molecular testing for lung cancer is relatively low across the world. Barriers include cost, access, quality, turnaround time, and lack of awareness.
INTRODUCTION: Access to targeted therapies for lung cancer depends on the accurate identification of patients' biomarkers through molecular testing. The International Association for the Study of Lung Cancer (IASLC) conducted an international survey to evaluate perceptions on current practice and barriers to implementation of molecular testing. METHODS: We distributed the survey to IASLC members and other health care professionals around the world. The survey included a seven-question introduction for all respondents, who then answered according to one of three tracks: (1) requesting tests and treating patients, (2) performing and interpreting assays, or (3) tissue acquisition. Barriers to implementing molecular testing were provided in free-response fields. The chi-square test was used for regional comparisons. RESULTS: A total of 2537 respondents from 102 countries participated. Most respondents who test and treat patients believe that less than 50% of patients with lung cancer in their country receive molecular testing, but reported higher rates within their own practice. Although many results varied by region, the five most frequent barriers cited in all regions were cost, quality and standards, access, awareness, and turnaround time. Many respondents expressed dissatisfaction with the current state of molecular testing for lung cancer, including 41% of those performing and interpreting assays. Issues identified included trouble understanding results (37%) and the quality of the samples (23% reported >10% rejection rate). Despite concerns regarding the quality of testing, 47% in the performing and interpreting track stated there is no policy or strategy to improve quality in their country. In addition, 33% of respondents who request tests and treat patients were unaware of the most recent College of American Pathologists, IASLC, and Association for Molecular Pathology guidelines for molecular testing. CONCLUSIONS: Adoption of molecular testing for lung cancer is relatively low across the world. Barriers include cost, access, quality, turnaround time, and lack of awareness.
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