Lung cancer strikes 1.8 million people globally each year and is a leading cause of death.1 Most lung cancer cases are non–small-cell lung cancer (NSCLC).2 There is a <20% 5-year survival rate for NSCLC patients, although with the recent development of targeted therapies for advanced-stage NSCLC harboring specific gene mutations, survival rates have improved.3 Identification of these genetic alterations and administration of targeted therapy accurately and in a timely manner greatly reduces the risk of death. Tumor samples, blood samples to detect circulating tumor DNA, or immunohistochemical tests can be used to detect tumors. Guidelines established in 2013 recommend testing for EGFR and ALK for all patients with NSCLC, with recommendations updated in 2018 for additional gene alterations (ROS1, HER2, MET, BRAF, KRAS, and RET).3
Despite these recommendations, and the patient benefit conveyed through molecular testing, many eligible patients fail to receive timely and appropriate therapy. In an attempt to understand why this happens, the International Association for the Study of Lung Cancer (IASLC) conducted an international survey in 2018 to identify the barriers to molecular testing.
Responses were received over a 7-month period from 2537 participants from 102 countries, which were grouped into 5 geographic regions. Respondents included IASLC members, physicians, nurses, pharmacists, advanced practice providers, and other allied healthcare professionals who care for patients with lung cancer. After an initial 7-question introduction, respondents were asked to choose 1 of 3 tracks: those who request tests and treat patients, those who perform and interpret assays, and those who obtain tissue samples. All respondents had the opportunity to provide feedback on barriers to molecular testing.
Responses were received from the following geographic regions: Asia (52%), Europe (19%), Latin America (11%), the United States and Canada (11%), and the rest of the world (7%).3 Medical oncologists were the majority of respondents (45%), and 66% of respondents were clinicians who requested testing and treated patients.3 Respondents were allowed to choose multiple institution types.3 The majority of institution types were 43% academic, 47% government, and 21% private practice.3
Most participants (61%) in the requesting and treating track responded that <50% of patients with lung cancer received molecular testing in their country, but this perception varied by region. Conversely, 64% indicated that in their own clinics >50% of patients received molecular testing. Barriers to testing varied by region, but the most frequently cited barrier was cost, followed by access, awareness, quality and standards, and test turnaround time.3 There was also dissatisfaction with the current state of molecular testing, with 41% of those who perform and interpret assays reporting dissatisfaction.3 In addition, 37% of respondents cited trouble understanding results, 23% of respondents reported a >10% rejection of submitted samples, 47% reported there was no quality improvement policy or strategy in their country, and 33% of respondents were unaware of the most recent guidelines for molecular testing.3
There are multiple barriers to molecular testing in patients with lung cancer globally. The authors suggest intensifying education on molecular testing in lung cancer to overcome many of these barriers.
References
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-249.
- American Cancer Society. Cancer Facts & Figures 2021. www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html. Accessed May 23, 2021.
- Smeltzer MP, Wynes MW, Lantuejoul S, et al. The International Association for the Study of Lung Cancer global survey on molecular testing in lung cancer. J Thorac Oncol. 2020;15:1434-1448.
