The CATCH: In Support of Biomarker Testing

This article is supported by funding from AstraZeneca

Kimary Kulig, PhD, MPH, at My Biomarker Navigator

Kimary applied insight and understanding of the biomarker world to advocate on behalf of her patient. In an evaluative manner, she highlights a need for best practice in the biomarker process.

—Sharon Gentry, MSN, RN, HON-ONN- CG, AOCN, CBCN; AONN+; and Journal of Oncology Navigation & Survivorship

A CATCH is a navigation success story where a navigation tactic improved a patient’s situation. The CATCH Initiative, short for Catching & Addressing Threats to Care & Health, tracks and acknowledges positive outcomes of navigation tactics.

THE CATCH OF THE MONTH

Background: A newly diagnosed, fit, male neversmoker patient with non–small cell lung cancer (NSCLC) and multiple metastases being seen in a community hospital in Wisconsin was referred to My Biomarker Navigator for navigational support.

The Incident: A healthy athlete complaining of back pain was scanned, revealing multiple metastases, including bone and brain, from a suspected lung primary. An iliac bone biopsy was performed to make a primary tumor diagnosis. Due to the heavy tumor burden and symptoms, it was urgent that the patient be seen by a thoracic oncologist as soon as possible to order critical biomarker testing for treatment assignment. The wait time for an oncology appointment was more than 2 weeks. Radiation oncology wanted to start whole brain irradiation immediately prior to oncologist consult and biomarker testing.

The CATCH (Intervention): The advanced practice patient navigator immediately suspected oncogene driver mutation in this otherwise very healthy never-smoker. She reviewed the surgical pathology report from the bone biopsy, catching the phrase “biomarker testing will be attempted but may not be successful given the limited amount of tumor cells.” Knowing that this was a bone biopsy and that a decalcification step would be required for DNA sequencing, and that this step would further reduce the odds of a successful tissue-based result, the navigator immediately explained this to the patient and his family. She asked to speak to the surgeon to discuss this and to explore an alternative testing mode for possible success and time efficiency. The thought was to suggest that a blood-based biopsy sequencing test be ordered immediately. The bone tissue specimen would likely fail sequencing, and the bloodbased test would be faster, thus time to treatment could be shortened. The surgeon felt this was reasonable but pointed out that an oncologist would need to order this test. The patient had not yet seen an oncologist, so the navigator helped the patient expedite seeing an oncologist at another clinic in the area. The clinic explained that they could not order the blood-based biomarker test until the oncologist sees the patient. This led to another collaborative conversation with the oncologist and navigator, and the outcome was a biomarker testing order prior to the patient’s first appointment.

Outcome: The biomarker test confirmed the suspected EGFR mutation, and the patient was immediately prescribed an EGFR inhibitor. The navigator spoke with the oncologist about choosing an EGFR inhibitor that would cross the blood–brain barrier given the patient’s brain metastases. Unfortunately, the patient suffered cardiac complications from heavy tumor burden and ultimately succumbed prior to receiving the inhibitor. This demonstrates the need for reflex biomarker testing in NSCLC (eg, ordered by pathology vs the oncologist) to shorten time to therapy administration as much as possible.

The Importance of the CATCH

This CATCH highlights that navigators must maintain a working knowledge of evidence-based information to ensure the quality of the navigation practice. They advocate on behalf of patients and their families with members of the healthcare team and work to continuously improve organizational culture and care processes to enhance communication and timely care in the best interests of patients.

Source

• Bellomo C, Christensen D, Strusowski T. Seasoned navigator: a case study on patient advocacy/patient empowerment. Journal of Oncology Navigation & Survivorship. 2016;7(8):31-32.

Read The CATCH: In Support of Multidisciplinary Communication  »

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