The American College of Chest Physicians (ACCP) recently partnered with Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) on a survey exploring how pulmonologists from ACCP incorporate biomarker testing into the care of patients with lung cancer; a similar survey was also conducted by Boehringer Ingelheim among pathologists. The survey results point to an increased role of these physicians in biomarker testing, as well as greater multidisciplinary collaboration. They also reveal an opportunity to improve how soon these tests are requested and to identify challenges with testing, including collecting a sufficient amount and quality of lung tissue.
Biomarker testing is critical in the diagnosis of lung cancer, as it helps physicians determine a patient’s specific type of cancer and inform a personalized treatment approach.
The results from the two surveys reflect responses and experiences of 100 ACCP pulmonologists and 250 pathologists practicing in the U.S. The surveys were conducted online by Harris Interactive in November and December 2012.
Facing Similar Challenges
The two surveys revealed the potential need for consistent guidelines on the size and quality of tissue needed to perform biomarker testing. Both pulmonologists and pathologists said the biggest challenges with biomarker testing include not always acquiring a tissue sample that is sufficient in size (60% and 73%, respectively) or quality (31% and 39%, respectively). About half of pulmonologists (41%) do not believe they have enough information about the size of tissue needed. (See Fig. 1.)
Differing Opinions
Survey responses highlighted a difference in opinions around the most appropriate tissue acquisition methods: 51% of pulmonologists believed endoscope biopsy to be the method yielding the most appropriate balance between quantity and quality of tissue and risk to the patient; just 15% of pathologists agreed. In contrast, one-third of pulmonologists (33%) believed fine needle aspiration to be the best method, with only 10% of pathologists agreeing. Interestingly, 63% of pathologists and 44% of pulmonologists believe core biopsy to be the most appropriate method.
These findings suggest a need for greater guidance around the proper techniques to obtain tissue samples of adequate size and quality at first biopsy. This is not only important for an accurate and rapid diagnosis, which can help inform treatment decisions, but also important for patients who would otherwise be subjected to additional risk by undergoing more than one invasive procedure to gather enough tissue samples for testing.
Opportunity for Greater Adoption of ‘Reflex’ Testing Exists
Through reflex – or automatic – testing in advanced non-small cell lung cancer (NSCLC), tissue samples are tested for biomarkers immediately after diagnosis, with the goal of allowing oncologists to review the results before the patient’s first visit. The results from surveyed pulmonologists and pathologists suggest that they have started to embrace reflex testing, but there is potential to increase its use.
Specifically, nearly half (43%) of pulmonologists and one-third (33%) of pathologists implement reflex testing in their practice or local health-care community for patients with NSCLC. (See Fig. 2.)
Greater collaboration with the multidisciplinary team
In what should be good news for patients, the survey also showed that pulmonologists and pathologists are increasingly utilizing a multidisciplinary approach to care. In fact, pulmonologists and pathologists report having increased discussions with a multidisciplinary team over the past 5 years (65% and 57%, respectively), and most pulmonologists and pathologists report consulting with oncologists (85% and 92%, respectively). (See Fig. 3.)
"The medical community is moving in a positive direction, but an opportunity exists for greater collaboration in incorporating biomarker testing into a patient’s care early on, with the goal of initiating an appropriate lung cancer treatment plan as soon as possible," said Kevin Lokay, vice president and business unit head, Oncology, Boehringer Ingelheim Pharmaceuticals, Inc. "It is encouraging to see how a multidisciplinary approach to testing is becoming more common in the diagnosis and care of cancer patients."
The surveys complement Boehringer Ingelheim’s Let’s Test initiative, which aims to educate health-care professionals about the important role they play in the diagnosis and treatment of NSCLC, and the critical role of biomarker testing.
If you would like to learn more about what ACCP is doing in the area of caring for patients with lung cancer, the new ACCP Lung Cancer Guidelines, 3rd edition, is being published as a supplement to CHEST in May 2013. Visit journal.publications.chestnet.org/ for more information.
Disclaimer: The data obtained from these surveys are self-reported and subjective; the ACCP was not directly involved in the writing of the survey questions, but rather participated by facilitating the collection of anonymous responses from its members.