C-A3-01: Current Use of KRAS Testing in Clinical Practice.

Somkin C, Liljestrand P, Harris J, Kolevska T, Alexander G, Kauffman T, McCarty C, O'Neil S, Pawloski P, Rahm A, Williams A, Goddard K.

Abstract

Background/Aims Provisional clinical guidelines, published by the American Society of Clinical Oncology in 2009, recommend that patients with metastatic colon cancer (mCRC) be tested for mutations in the Kirsten ras (KRAS) oncogene, and that patients found to have the non mutated KRAS gene be offered anti-epidermal growth factor receptor (EGFR) antibody therapy. Such therapy has been shown to extend life; yet it is also expensive and frequently associated with severe side-effects. Currently, little is known about how clinicians are using KRAS testing in clinical practice. This study compares the adoption of policies for and usage of KRAS testing and anti-EGFR therapy in clinical practice among seven integrated health delivery systems. The purposes were to examine 1) physicians' attitudes toward and experiences with KRAS testing and the communication process with their patients, 2) patients' experiences with KRAS testing and anti-EGFR therapy and associated quality-of-life issues, and 3) the adoption of policies for KRAS testing and anti-EGFR therapy at the different health plans. Methods Data collection includes 1) semi-structured interviews with 33 oncologists at the participating HMORN sites, one leader at each site, and 20 mCRC patients in KPNC, and 2) collection of policy documents from each site. Coding is conducted through an iterative process by three social scientists. Results To date, twenty-eight 15-30 minute physician interviews have been conducted; coding and data analysis has begun. For this meeting, we will focus on the range of practices among the physicians, specifically addressing following questions: To what extent have oncologists adopted the KRAS test? At what point in the clinical process do they test for KRAS? What concerns regarding the KRAS test do they articulate? To what extent do costs (of the test, of treatment) feature into their treatment decisions? How do oncologists incorporate patients into the treatment decision making process? To what extent are these physicians adhering to guidelines for KRAS testing vs. considering the specifics of each case in their treatment plan? Conclusions We expect that the results will shed light on how recommendations for KRAS testing are translated into clinical practice.