Clinical decisions surrounding genomic and proteomic testing among United States veterans treated for lung cancer within the Veterans Health Administration
| Autor: | Brygida Berse, Kelly K. Filipski, Michael S. Icardi, Scott L. DuVall, Olga Efimova, Daniel W. Denhalter, Michael J. Kelley, Julie Lynch |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Oncology
Proteomics Lung Neoplasms Tyrosine kinase inhibitor Health informatics 0302 clinical medicine Non-small cell lung cancer Carcinoma Non-Small-Cell Lung VeriStrat Electronic Health Records 030212 general & internal medicine Aged 80 and over Medical Audit Health Policy Clinical decision support Genomics Middle Aged Computer Science Applications ErbB Receptors United States Department of Veterans Affairs Erlotinib 030220 oncology & carcinogenesis Biomarker (medicine) lcsh:R858-859.7 Veristrat medicine.drug Research Article medicine.medical_specialty Decision Making Health Informatics Pharmacy lcsh:Computer applications to medicine. Medical informatics Clinical decision support system 03 medical and health sciences Internal medicine medicine Humans Intensive care medicine Lung cancer Veterans Affairs Aged Retrospective Studies Polymorphism Genetic business.industry Epidermal growth factor receptor Proteomic Testing algorithm Biomarker medicine.disease United States Genomic business |
| Zdroj: | BMC Medical Informatics and Decision Making, Vol 17, Iss 1, Pp 1-8 (2017) BMC Medical Informatics and Decision Making |
| ISSN: | 1472-6947 |
| DOI: | 10.1186/s12911-017-0475-8 |
| Popis: | Background Current clinical guidelines recommend epidermal growth factor receptor (EGFR) mutational testing in patients with metastatic non-small cell lung cancer (NSCLC) to predict the benefit of the tyrosine kinase inhibitor erlotinib as first-line treatment. Proteomic (VeriStrat) testing is recommended for patients with EGFR negative or unknown status when erlotinib is being considered. Departure from this clinical algorithm can increase costs and may result in worse outcomes. We examined EGFR and proteomic testing among patients with NSCLC within the Department of Veterans Affairs (VA). We explored adherence to guidelines and the impact of test results on treatment decisions and cost of care. Methods Proteomic and EGFR test results from 2013 to 2015 were merged with VA electronic health records and pharmacy data. Chart reviews were conducted. Cases were categorized based on the appropriateness of testing and treatment. Results Of the 69 patients with NSCLC who underwent proteomic testing, 33 (48%) were EGFR-negative and 36 (52%) did not have documented EGFR status. We analyzed 138 clinical decisions surrounding EGFR/proteomic testing and erlotinib treatment. Most decisions (105, or 76%) were concordant with clinical practice guidelines. However, for 24 (17%) decisions documentation of testing or justification of treatment was inadequate, and 9 (7%) decisions represented clear departures from guidelines. Conclusion EGFR testing, the least expensive clinical intervention analyzed in this study, was significantly underutilized or undocumented. The records of more than half of the patients lacked information on EGFR status. Our analysis illustrated several clinical scenarios where the timing of proteomic testing and erlotinib diverged from the recommended algorithm, resulting in excessive costs of care with no documented improvements in health outcomes. |
| Databáze: | OpenAIRE |
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