A multi-pronged intervention can increase biomarker testing in patients with metastatic non-small cell lung cancer (NSCLC), according to a study published in the Journal of Clinical Oncology.

The intervention was implemented at a large oncology practice and increased the rate of biomarker testing from 68% to 92.7% over a 1-year period.

The intervention began with provider education. Researchers developed a template to support providers in following National Comprehensive Cancer Network testing and staging guidelines for patients with metastatic NSCLC

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The researchers also produced videos to educate providers on the new template, how to order testing, and the importance of biomarkers. Mandatory 1-on-1 teaching sessions with providers were implemented to ensure their understanding and compliance.

During this process, the researchers uncovered inaccurate staging of NSCLC and failures to update charts. To fix these problems, the researchers began generating a weekly spreadsheet to identify patients meeting eligibility for this intervention. 

The spreadsheet was also used to record data that was not always in the electronic health record. The researchers contacted providers whose records were missing information and informed them of the corrections needed. 

From September 1, 2021, to August 31, 2022, there were 111 NSCLC patients who met criteria for study inclusion and had stage IV disease.

A total of 103 patients (93%) had orders for comprehensive biomarker testing. Of the 8 patients who did not have orders, 5 were referred to hospice care, 2 declined treatment, and 1 refused testing.

Among the 103 patients who had biomarker testing ordered, 95 (92%) had their test results recorded in their charts. Results were still pending in 1 patient. Other reasons for a lack of results included 1 patient refusing testing after it had been ordered, 2 patients not returning for follow-up, and 1 patient having an insufficient tissue sample.

The overall testing rate during the intervention period was 92.7%, which was an increase from 68% before the intervention, the researchers noted.

Most providers (71%) used the new metastatic NSCLC template. Complete and accurate TNM staging and relevant biomarkers were recorded in 40% of patients with metastatic NSCLC.

“Implementation and standardization of comprehensive biomarker testing of patients with [metastatic] NSCLC in a large multisite community-based oncology practice is feasible and results in significant improvement in comprehensive biomarker testing and reporting,” the researchers concluded. “Establishing reliable and measurable tracking metrics to ensure that these new processes are used and maintained can assist in scaling these processes.”

Disclosures: This research was supported by Pfizer. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Waterhouse DM, Ward P, Arnal S, et al. Closing the testing gap: Standardization of comprehensive biomarker testing for metastatic non–small-cell lung cancer in a large community oncology practice. J Clin Oncol. Published online May 1, 2023. doi:10.1200/OP.22.00817