Cargando…
Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013
BACKGROUND: Tumor testing for mutations in the epidermal growth factor receptor (EGFR) gene is indicated for all newly diagnosed, metastatic lung cancer patients, who may be candidates for first-line treatment with an EGFR tyrosine kinase inhibitor. Few studies have analyzed population-level testing...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859516/ https://www.ncbi.nlm.nih.gov/pubmed/29554880 http://dx.doi.org/10.1186/s12885-018-4190-3 |
_version_ | 1783307839400312832 |
---|---|
author | Lynch, Julie A. Berse, Brygida Rabb, Merry Mosquin, Paul Chew, Rob West, Suzanne L. Coomer, Nicole Becker, Daniel Kautter, John |
author_facet | Lynch, Julie A. Berse, Brygida Rabb, Merry Mosquin, Paul Chew, Rob West, Suzanne L. Coomer, Nicole Becker, Daniel Kautter, John |
author_sort | Lynch, Julie A. |
collection | PubMed |
description | BACKGROUND: Tumor testing for mutations in the epidermal growth factor receptor (EGFR) gene is indicated for all newly diagnosed, metastatic lung cancer patients, who may be candidates for first-line treatment with an EGFR tyrosine kinase inhibitor. Few studies have analyzed population-level testing. METHODS: We identified clinical, demographic, and regional predictors of EGFR & KRAS testing among Medicare beneficiaries with a new diagnosis of lung cancer in 2011–2013 claims. The outcome variable was whether the patient underwent molecular, EGFR and KRAS testing. Independent variables included: patient demographics, Medicaid status, clinical characteristics, and region where the patient lived. We performed multivariate logistic regression to identify factors that predicted testing. RESULTS: From 2011 to 2013, there was a 19.7% increase in the rate of EGFR testing. Patient zip code had the greatest impact on odds to undergo testing; for example, patients who lived in the Boston, Massachusetts hospital referral region were the most likely to be tested (odds ratio (OR) of 4.94, with a 95% confidence interval (CI) of 1.67–14.62). Patient demographics also impacted odds to be tested. Asian/Pacific Islanders were most likely to be tested (OR 1.63, CI 1.53–1.79). Minorities and Medicaid patients were less likely to be tested. Medicaid recipients had an OR of 0.74 (CI 0.72–0.77). Hispanics and Blacks were also less likely to be tested (OR 0.97, CI 0.78–0.99 and 0.95, CI 0.92–0.99), respectively. Clinical procedures were also correlated with testing. Patients who underwent transcatheter biopsies were 2.54 times more likely to be tested (CI 2.49–2.60) than those who did not undergo this type of biopsy. CONCLUSIONS: Despite an overall increase in EGFR testing, there is widespread underutilization of guideline-recommended testing. We observed racial, income, and regional disparities in testing. Precision medicine has increased the complexity of cancer diagnosis and treatment. Targeted interventions and clinical decision support tools are needed to ensure that all patients are benefitting from advances in precision medicine. Without such interventions, precision medicine may exacerbate racial disparities in cancer care and health outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12885-018-4190-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5859516 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58595162018-03-20 Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 Lynch, Julie A. Berse, Brygida Rabb, Merry Mosquin, Paul Chew, Rob West, Suzanne L. Coomer, Nicole Becker, Daniel Kautter, John BMC Cancer Research Article BACKGROUND: Tumor testing for mutations in the epidermal growth factor receptor (EGFR) gene is indicated for all newly diagnosed, metastatic lung cancer patients, who may be candidates for first-line treatment with an EGFR tyrosine kinase inhibitor. Few studies have analyzed population-level testing. METHODS: We identified clinical, demographic, and regional predictors of EGFR & KRAS testing among Medicare beneficiaries with a new diagnosis of lung cancer in 2011–2013 claims. The outcome variable was whether the patient underwent molecular, EGFR and KRAS testing. Independent variables included: patient demographics, Medicaid status, clinical characteristics, and region where the patient lived. We performed multivariate logistic regression to identify factors that predicted testing. RESULTS: From 2011 to 2013, there was a 19.7% increase in the rate of EGFR testing. Patient zip code had the greatest impact on odds to undergo testing; for example, patients who lived in the Boston, Massachusetts hospital referral region were the most likely to be tested (odds ratio (OR) of 4.94, with a 95% confidence interval (CI) of 1.67–14.62). Patient demographics also impacted odds to be tested. Asian/Pacific Islanders were most likely to be tested (OR 1.63, CI 1.53–1.79). Minorities and Medicaid patients were less likely to be tested. Medicaid recipients had an OR of 0.74 (CI 0.72–0.77). Hispanics and Blacks were also less likely to be tested (OR 0.97, CI 0.78–0.99 and 0.95, CI 0.92–0.99), respectively. Clinical procedures were also correlated with testing. Patients who underwent transcatheter biopsies were 2.54 times more likely to be tested (CI 2.49–2.60) than those who did not undergo this type of biopsy. CONCLUSIONS: Despite an overall increase in EGFR testing, there is widespread underutilization of guideline-recommended testing. We observed racial, income, and regional disparities in testing. Precision medicine has increased the complexity of cancer diagnosis and treatment. Targeted interventions and clinical decision support tools are needed to ensure that all patients are benefitting from advances in precision medicine. Without such interventions, precision medicine may exacerbate racial disparities in cancer care and health outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12885-018-4190-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-03-20 /pmc/articles/PMC5859516/ /pubmed/29554880 http://dx.doi.org/10.1186/s12885-018-4190-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Lynch, Julie A. Berse, Brygida Rabb, Merry Mosquin, Paul Chew, Rob West, Suzanne L. Coomer, Nicole Becker, Daniel Kautter, John Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 |
title | Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 |
title_full | Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 |
title_fullStr | Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 |
title_full_unstemmed | Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 |
title_short | Underutilization and disparities in access to EGFR testing among Medicare patients with lung cancer from 2010 – 2013 |
title_sort | underutilization and disparities in access to egfr testing among medicare patients with lung cancer from 2010 – 2013 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859516/ https://www.ncbi.nlm.nih.gov/pubmed/29554880 http://dx.doi.org/10.1186/s12885-018-4190-3 |
work_keys_str_mv | AT lynchjuliea underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT bersebrygida underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT rabbmerry underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT mosquinpaul underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT chewrob underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT westsuzannel underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT coomernicole underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT beckerdaniel underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 AT kautterjohn underutilizationanddisparitiesinaccesstoegfrtestingamongmedicarepatientswithlungcancerfrom20102013 |