No significant differences were found in the rates of predictive biomarker testing or administration of first-line, biomarker-guided targeted therapy for patients with advanced non-small cell lung cancer (NSCLC) treated at practices participating in the Oncology Care Management (OCM) Model vs practices that did not, according to results of a retrospective study published in JCO Oncology Practice.
The Centers for Medicare and Medicaid (CMS) Oncology Care Management (OCM) Model is a voluntary payment model program initiated in 2016, in which participating physician practices have financial and performance accountability to improve the coordination and delivery of appropriate care to their patients with cancer.
However, the study authors noted that at the present time, “there are limited published data evaluating the impact of the OCM on downstream outcomes of interest.”
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Beginning in October 2017, OCM practices were required to collect and report data related to the proportion of their patients with advanced NSCLC who underwent testing for established biomarkers predictive of benefit from treatment with specific tyrosine kinase inhibitor (TKI) therapy (eg, EGFR, ROS1, and ALK mutations), as well as data regarding the proportion of these patients who received biomarker-guided therapy in the first-line setting, including non–TKI-based therapy for those with disease not characterized by these biomarkers.
The aim of this study, which utilized Flatiron Health information from a nationwide, longitudinal database derived from patient electronic health records, was to determine whether these rates differed in OCM vs non-OCM practices.
Included in the study were patients diagnosed with advanced, nonsquamous NSCLC between January 2011 and November 2018 who were aged at least 65 years at the time of diagnosis and received first-line therapy at a community oncology clinic.
The OCM status for the oncology practice treating each patient was determined on the date of diagnosis of advanced NSCLC. In addition, patients were further classified into 3 groups based on the initiation of the OCM program and its establishment of requirements related to biomarker testing: (1) pre-period (January 2011 through December 2015) corresponding to the period prior to initiation of OCM; (2) implementation wash-out period (January 2016 through September 2017) corresponding the period following initiation of OCM but prior to requirements related to predictive biomarker testing; and (3) post-period (October 2017 through November 2018) corresponding to a period when collection of predictive biomarker testing and its use to guide treatment selection were required by OCM.
Of the 14,048 patients meeting inclusion criteria within one of these 3 classes, 8151 and 5897 were treated at 1 of 45 OCM vs 1 of 105 non-OCM practices, respectively. Evidence was found for biomarker testing in 8652 (61.8%) of these patients, with 96% of these patients receiving a determinate result on the first test.
Baseline characteristics for patients in the overall study sample included a median age of 73 years, with 50%, 70.3%, and 83.6% identified as female, non-Hispanic white, and having a smoking history, respectively, and were similar for those treated at OCM compared with non-OCM practices.
A key study finding was that there was no significant difference in the unadjusted rates of patients who undergo biomarker testing during the pre-period for OCM (55.1%) vs non-OCM (55.5%) practice sites. While biomarker testing rates were found to increase over time, rates of testing for OCM (71.6%) and non-OCM (69.7%) practices during the post-period were also similar. Furthermore, adjustments for confounders, including age, year of diagnosis, sex, race and ethnicity, and smoking status, did not alter the finding of an absence of OCM status on rates of biomarker testing.
Results of analyses of rates of tested patients who received biomarker-guided therapy were also similar for patients treated at an OCM vs a non-OCM practice during the pre-period (89.8% [OCM] vs 90.1% [non-OCM]) and the post-period (94.6% [OCM] vs 95.2% [non-OCM]), In addition, this finding was not altered when these rates were adjusted for potential confounders.
Some of the study limitations mentioned by the study authors were inclusion of EGFR mutations that may not be predictive of increased sensitivity to available EGFR inhibitor therapy, as well as the possibility that some patients were treated with “non-TKI” targeted therapy on a clinical trial.
In their concluding remarks, the study authors noted that “evaluation of reporting requirements may provide insight into their overall utility and whether the infrastructure built to meet them could also be used to not just measure but also improve patient care.”
Reference
Castellanos EH, Orlando A, Ma X, et al. Evaluating the impact of Oncology Care Model reporting requirements on biomarker testing and treatment [published online June 4, 2020]. JCO Oncol Pract. doi: 10.1200/JOP.19.00747
