Low Global Molecular Testing for Lung Cancer Calls for More Education

A study published in the Journal of Thoracic Oncology suggested that the adoption of molecular testing for lung cancer is globally relatively low due to barriers including cost, access, quality, turn-around time, and lack of awareness.¹

Given these findings, researchers indicated that continuous education around molecular testing in lung cancer should be intensified on both national and international levels to ensure patients receive optimal therapy. 

“The landscape of molecular testing is complex and rapidly evolving, highlighting the need for regular updates to expert statements and guidelines,” the authors wrote. “Many of the barriers identified can be address with improved awareness and standardization of processes.”

In order to address the knowledge gap, the International Association for the Study of Lung Cancer (IASLC) conducted an international survey to assess current practices and possible barriers to molecular testing. The survey included a 7-question introduction for all respondents, who then answered according to 1 of 3 tracks, including:

• Requesting tests/treating patients

• Performing/interpreting assays

• Tissue acquisition 

Moreover, barriers to implementing molecular testing were provided in free-response fields within the questionnaire. 

In total, 2,537 respondents across 102 countries participated in the survey. Overall, most respondents testing/treating patients reported <50% of patients with lung cancer in their country receive molecular testing, but reported higher rates within their own practice. 

Though the results varied by region, the 5 most frequent barriers reported in all regions were cost, quality/standards, access, awareness, and turnaround time. Additionally, many respondents expressed discontent with the current state of molecular testing for lung cancer, including 41% of those performing/interpreting assays. Specific issues identified included trouble understanding results (37%) and quality of the samples (23% report >10% rejection rate). 

However, despite concerns regarding quality testing, 47% of the performing/interpreting track respondents indicated that there is no policy or strategy to improve quality in their country. Even further, 33% of respondents who request tests/treat patients were unaware of the most recent guidelines for molecular testing. 

“The risk of death for patients with non-small cell lung cancer is substantially reduced when a gene alteration is identified and the available targeted therapy is administered,” lead author Matthew Smeltzer, PhD, IASLC committee member and assistant professor of Epidemiology and Biostatistics at the University of Memphis, said in a press release.² ”But one-third of respondents were unaware of evidence-based guidelines that recommend using these therapies.”

In order to further mitigate the concerns raised by this study, researchers suggested that the IASLC and other groups develop educational initiatives aimed to improve technical knowledge and awareness of guidelines with increased education. In addition, guidelines could be revised more frequently to remain up-to-date on the latest evidence-based practices. Even further, expanding guidelines to establish minimal standards for molecular testing in lung cancer, and finding additional avenues to promote best practices, could improve the frequency and quality of testing.

“Both awareness of, and concordance with evidence-based guidelines are important issues that need to be addressed further by the lung cancer community. Furthermore, given the rapidly evolving science around targeted therapies in lung cancer, more frequent guidelines may be warranted,” the authors wrote. “The findings of this survey can inform the development of solutions that can be applied broadly and those that can be tailored to specific regions.”

References:

1. Smeltzer MP, Wynes MW, Lantuejoul S, et al. The International Association for the Study of Lung Cancer (IASLC) Global Survey on Molecular Testing in Lung Cancer. Journal of Thoracic Oncology. doi:10.1016/j.jtho.2020.05.002.

2. IASLC Survey: Molecular Testing Rates in Most Countries Less than 50 Percent [news release]. Denver. Published May 20, 2020. iaslc.org/About-IASLC/News-Detail/iaslc-survey-molecular-testing-rates-in-most-countries-less-than-50-percent. Accessed May 20, 2020.