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Observational Study
. 2013 Aug;15(8):630-8.
doi: 10.1038/gim.2013.5. Epub 2013 Feb 28.

Utilization of epidermal growth factor receptor (EGFR) testing in the United States: a case study of T3 translational research

Julie A Lynch  1 , Muin J Khoury, Ann Borzecki, Jerry Cromwell, Laura L Hayman, Pat Reid Ponte, Glenn A Miller, Christopher S Lathan
Affiliations
Observational Study

Utilization of epidermal growth factor receptor (EGFR) testing in the United States: a case study of T3 translational research

Julie A Lynch et al. Genet Med. 2013 Aug.

Abstract

Purpose: We examined hospital use of the epidermal growth factor receptor assay in patients with lung cancer in the United States. Our goal was to inform the development of a model to predict phase 3 translation of guideline-directed molecular diagnostic tests.

Methods: This was a retrospective observational study. Using logistic regression, we analyzed the association between hospitals' institutional and regional characteristics and the likelihood that an epidermal growth factor receptor assay would be ordered.

Results: Significant institutional predictors included affiliation with an academic medical center (odds ratio, 1.48; 95% confidence interval, 1.20-1.83), participation in a National Cancer Institute clinical research cooperative group (odds ratio, 2.06, 1.66-2.55), and -availability of positron emission tomography scan (odds ratio, 1.44, 1.07-1.94) and cardiothoracic surgery (odds ratio, 1.90, 1.52-2.37) services. Significant regional predictors included metropolitan county (odds ratio, 2.08, 1.48-2.91), population with above-average education (odds ratio, 1.46, 1.09-1.96), and population with above-average income (odds ratio, 1.46, 1.04-2.05). Distance from a National Cancer Institute cancer center was a negative predictor (odds ratio, 0.996, 0.995-0.998), with a 34% decrease in likelihood for every 100 miles.

Conclusion: In 2010, only 12% of US acute-care hospitals ordered the epidermal growth factor receptor assay, suggesting that most patients with lung cancer did not have access to this test. This case study illustrated the need for: (i) increased dissemination and implementation research, and (ii) interventions to improve adoption of guideline-directed molecular diagnostic tests by community hospitals.

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Conflict of interest statement

Conflicts of interest statement: Glenn Miller reports the following conflicts: He is currently Vice President and Head of Strategy, Portfolio and Alliance for Personalized Healthcare & Biomarkers at AstraZeneca Pharmaceuticals, LP. He was formerly Vice President and General Manager of a division of Genzyme Genetics, Genzyme Analytical Services. All other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Acute care hospitals that ordered the EGFR assay in 2010
Figure 2
Figure 2
a. Hospital characteristics by status of ordering EGFR assay b. Membership in cooperative group by status of ordering EGFR assay
See this image and copyright information in PMC

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