Researchers recommend that patients with newly diagnosed non-small cell lung cancer (NSCLC) and colorectal cancer (CRC) receive molecular testing to identify those who can benefit from targeted therapies. However, many patients do not receive such testing or therapies. A new study, published Friday in JAMA Network Open, sought to compare rates of molecular testing and targeted therapy use by practice type and across oncology practices.
The cross-sectional study used 100% Medicare fee-for-service data from 2015 through 2019 to identify beneficiaries with new metastatic NSCLC or CRC diagnoses receiving systemic therapy, and to assign patients to oncology practices. Hierarchical linear models were used to characterize variation by practice type and across practices. Data analysis was conducted from June 2019 to October 2022.
Of 145,740 Medicare beneficiaries, there were 106,228 beneficiaries with NSCLC; 31,521 were ages 65 to 69 years; 50,348 were female; 2,269 Asian, 8,282 Black, and 91,215 white. There were 39,512 beneficiaries with CRC; 14,045 were ages 65 to 69 years; 17,518 were female; 896 Asian, 3,521 Black, and 32,753 white. Among these beneficiaries, 18,435 were treated at National Cancer Institute (NCI)-designated centers, 8,187 at other academic centers, and 94,329 at independent oncology practices.
Molecular testing rates increased from 74% to 85% for NSCLC and 45% to 65% for CRC from 2015 through 2019. Rates of first-line targeted therapy use decreased from 12% to 8% among patients with NSCLC, but remained stable at 5% for patients with CRC. Rates of molecular testing for NSCLC were similar across practice types, while rates of multigene panel use (13.2%) and targeted therapy use (16.6%) were highest at NCI-designated cancer centers.
Among patients with CRC, molecular testing was highest at NCI-designated cancer centers and academic centers, and targeted therapy use was similar across practice types. The molecular testing rates were 3.8, 3.3, and 12.2 percentage points lower, respectively, at hospital-owned practices, large independent practices, and small independent practices.
The researchers concluded that for Medicare beneficiaries the use of recommended molecular testing and targeted therapies varied by practice type among patients with NSCLC and CRC and, while molecular testing rates for NSCLC and CRC have increased in recent years, they remained lower than recommended levels. The findings suggest that substantial underuse of molecular testing and targeted therapies remains, with variation by practice type and patient characteristics.
The patterns observed suggest that the facility in which patients are treated may impact their access to recommended testing and treatments, and that socioeconomic disparities in access to testing and treatment persist. Efforts to improve access to molecular testing and targeted therapies are important to ensure that all patients benefit from advances in oncology care.