Utilization of epidermal growth factor receptor (EGFR) testing in the United States: a case study of T3 translational research.

Lynch JA, Khoury MJ, Borzecki A, Cromwell J, Hayman LL, Ponte PR, Miller GA, Lathan CS.

Source

1] Veterans Health Administration, University of Massachusetts Boston & Dana Farber Cancer Institute, Boston, Massachusetts, USA [2] Veterans Health Administration, Center for Health Quality, Outcomes, and Economic Research, Bedford, Massachusetts, USA.

Abstract

Purpose:We examined hospital use of the epidermal growth factor receptor assay in patients with lung cancer in the United States. Our goal was to inform the development of a model to predict phase 3 translation of guideline-directed molecular diagnostic tests.Methods:This was a retrospective observational study. Using logistic regression, we analyzed the association between hospitals' institutional and regional characteristics and the likelihood that an epidermal growth factor receptor assay would be ordered.Results:Significant institutional predictors included affiliation with an academic medical center (odds ratio, 1.48; 95% confidence interval, 1.20-1.83), participation in a National Cancer Institute clinical research cooperative group (odds ratio, 2.06, 1.66-2.55), and -availability of positron emission tomography scan (odds ratio, 1.44, 1.07-1.94) and cardiothoracic surgery (odds ratio, 1.90, 1.52-2.37) services. Significant regional predictors included metropolitan county (odds ratio, 2.08, 1.48-2.91), population with above-average education (odds ratio, 1.46, 1.09-1.96), and population with above-average income (odds ratio, 1.46, 1.04-2.05). Distance from a National Cancer Institute cancer center was a negative predictor (odds ratio, 0.996, 0.995-0.998), with a 34% decrease in likelihood for every 100 miles.Conclusion:In 2010, only 12% of US acute-care hospitals ordered the epidermal growth factor receptor assay, suggesting that most patients with lung cancer did not have access to this test. This case study illustrated the need for: (i) increased dissemination and implementation research, and (ii) interventions to improve adoption of guideline-directed molecular diagnostic tests by community hospitals.Genet Med advance online publication 28 February 2013Genetics in Medicine (2013); doi:10.1038/gim.2013.5.