Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration
Abstract Background Current 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...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-017-0475-8 |
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| author | Olga Efimova Brygida Berse Daniel W. Denhalter Scott L. DuVall Kelly K. Filipski Michael Icardi Michael J. Kelley Julie A. Lynch |
| author_facet | Olga Efimova Brygida Berse Daniel W. Denhalter Scott L. DuVall Kelly K. Filipski Michael Icardi Michael J. Kelley Julie A. Lynch |
| author_sort | Olga Efimova |
| collection | DOAJ |
| description | Abstract Background Current 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. Methods Proteomic 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. Results Of 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. Conclusion EGFR 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. |
| first_indexed | 2024-12-11T10:05:50Z |
| format | Article |
| id | doaj.art-3d478c1b7eaf418391bcb859a5898ca9 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-11T10:05:50Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-3d478c1b7eaf418391bcb859a5898ca92022-12-22T01:11:57ZengBMCBMC Medical Informatics and Decision Making1472-69472017-05-011711810.1186/s12911-017-0475-8Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health AdministrationOlga Efimova0Brygida Berse1Daniel W. Denhalter2Scott L. DuVall3Kelly K. Filipski4Michael Icardi5Michael J. Kelley6Julie A. Lynch7Department of Veterans Affairs Salt Lake City Health Care SystemBoston University School of MedicineDepartment of Veterans Affairs Salt Lake City Health Care SystemDepartment of Veterans Affairs Salt Lake City Health Care SystemNational Cancer Institute, NIHUniversity of Iowa Carver College of MedicineDurham VA Medical CenterDepartment of Veterans Affairs Salt Lake City Health Care SystemAbstract Background Current 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. Methods Proteomic 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. Results Of 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. Conclusion EGFR 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.http://link.springer.com/article/10.1186/s12911-017-0475-8BiomarkerProteomicGenomicTesting algorithmNon-small cell lung cancerVeriStrat |
| spellingShingle | Olga Efimova Brygida Berse Daniel W. Denhalter Scott L. DuVall Kelly K. Filipski Michael Icardi Michael J. Kelley Julie A. Lynch 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 Biomarker Proteomic Genomic Testing algorithm Non-small cell lung cancer VeriStrat |
| title | Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration |
| title_full | Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration |
| title_fullStr | Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration |
| title_full_unstemmed | Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration |
| title_short | Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration |
| title_sort | clinical decisions surrounding genomic and proteomic testing among united states veterans treated for lung cancer within the veterans health administration |
| topic | Biomarker Proteomic Genomic Testing algorithm Non-small cell lung cancer VeriStrat |
| url | http://link.springer.com/article/10.1186/s12911-017-0475-8 |
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