Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration

BMC Medical Informatics and Decision Making

Research Article

Brygida Berse¹  Olga Efimova²  Julie A. Lynch³  Scott L. DuVall⁴  Daniel W. Denhalter⁴  Michael J. Kelley⁵  Kelly K. Filipski⁶  Michael Icardi⁷ 

[1] Boston University School of Medicine, 715 Albany Street, 02118, Boston, MA, USA;Veterans Healthcare Administration Bedford, 200 Springs Rd, 01730, Bedford, MA, USA;RTI International, 307 Waverley Oaks Rd, 02452, Waltham, MA, USA;Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, 84148, Salt Lake City, UT, USA;Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, 84148, Salt Lake City, UT, USA;RTI International, 307 Waverley Oaks Rd, 02452, Waltham, MA, USA;University of Utah, 30 2000 E, 84112, Salt Lake City, UT, USA;University of Massachusetts College of Nursing & Health Sciences, 100 Morrissey Blvd, 02125, Boston, MA, USA;Department of Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, 84148, Salt Lake City, UT, USA;University of Utah, 30 2000 E, 84112, Salt Lake City, UT, USA;Durham VA Medical Center, 508 Fulton St, 27705, Durham, NC, USA;Duke University School of Medicine, 2301 Erwin Rd, 27710, Durham, NC, USA;National Cancer Institute, NIH, 9609 Medical Center Dr, 20850, Rockville, MD, USA;University of Iowa Carver College of Medicine, 200 Hawkins Drive, 52242, Iowa City, IA, USA;Iowa City VA Medical Center, 601 Highway 6 West, 52246-2208, Iowa City, IA, USA;

关键词: Biomarker;    Proteomic;    Genomic;    Testing algorithm;    Non-small cell lung cancer;    VeriStrat;    Epidermal growth factor receptor;    Tyrosine kinase inhibitor;    Erlotinib;    Clinical decision support;   

DOI  :  10.1186/s12911-017-0475-8

 received in 2016-12-21, accepted in 2017-05-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCurrent clinical guidelines recommend epidermal growth factor receptor (EGFR) mutational testing in patients with metastatic non-small cell lung cancer (NSCLC) to predict the benefit of the tyrosine kinase inhibitor erlotinib as first-line treatment. Proteomic (VeriStrat) testing is recommended for patients with EGFR negative or unknown status when erlotinib is being considered. Departure from this clinical algorithm can increase costs and may result in worse outcomes. We examined EGFR and proteomic testing among patients with NSCLC within the Department of Veterans Affairs (VA). We explored adherence to guidelines and the impact of test results on treatment decisions and cost of care.MethodsProteomic and EGFR test results from 2013 to 2015 were merged with VA electronic health records and pharmacy data. Chart reviews were conducted. Cases were categorized based on the appropriateness of testing and treatment.ResultsOf the 69 patients with NSCLC who underwent proteomic testing, 33 (48%) were EGFR-negative and 36 (52%) did not have documented EGFR status. We analyzed 138 clinical decisions surrounding EGFR/proteomic testing and erlotinib treatment. Most decisions (105, or 76%) were concordant with clinical practice guidelines. However, for 24 (17%) decisions documentation of testing or justification of treatment was inadequate, and 9 (7%) decisions represented clear departures from guidelines.ConclusionEGFR testing, the least expensive clinical intervention analyzed in this study, was significantly underutilized or undocumented. The records of more than half of the patients lacked information on EGFR status. Our analysis illustrated several clinical scenarios where the timing of proteomic testing and erlotinib diverged from the recommended algorithm, resulting in excessive costs of care with no documented improvements in health outcomes.

【 授权许可】

CC BY   
© The Author(s). 2017