Implementation of a multidisciplinary quality improvement initiative to improve molecular testing rates in advanced non-squamous non-small cell lung cancer.

Abstract

e18181 Background: EGFR mutations and ALK rearrangements are key therapeutic targets in nonsquamous nonsmall cell lung carcinoma (nsNSCLC). Treatment with targeted therapy has been shown to improve progression-free survival and overall survival in many cases. Current guidelines recommend testing all advanced (Stage IIIB and IV) nsNSCLC patients for these genetic aberrations. Our previous work revealed that we were not evaluating a large percentage of eligible patients. In order to improve testing rates, we conducted a series of multidisciplinary meetings aimed at direct physician education and process enhancement. Methods: Utilizing the Association of Community Cancer Centers (ACCC) molecular testing framework in conjunction with support from Pfizer, we launched a lean six sigma initiative aimed at improving our molecular profiling rates. A series of multidisciplinary meetings were conducted addressing action items outlined by the ACCC. A total of 158 advanced nsNSCLC patients were identified from our tumor registry during or shortly after the start of this initiative (2014-2015). Testing rates for EGFR and ALK were determined by individual chart review and compared to our previously published testing rates (2011-2013). Results: We found 77.9% (123/158) and 60.8% (96/158) of patients were tested for EGFR mutations and ALK rearrangements, respectively. We utilized a chi-square test of homogeneity to determine whether there was an increased EGFR and ALK testing rate post-intervention . Our EGFR testing rate increased 80.3%, from 43.2% (2011-2013) to 77.9% (2014-2015), p < 0.00001, and our ALK testing rate increased 155.5%, from 23.8% (2011-2013) to 60.8% (2014-2015), p < 0.00001. Conclusions: Multidisciplinary educational and process enhancement meetings improve molecular testing rates in nsNSCLC.