CHEST Guidelines-Health-Care-Provider-Practices-and-Perceptions-of-

Health-Care-Provider-Practices-and-Perceptions-of-

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The article addresses the utilization and perceptions of biomarker testing in U.S. Veterans with non-small cell lung cancer (NSCLC) within the Veterans Health Administration (VA), the largest integrated health system in the U.S. Precision medicine's influence on NSCLC treatment has necessitated biomarker testing, yet its implementation faces challenges. Despite guidelines recommending these tests due to their association with improved survival rates, there's underutilization and delays in the VA system. These issues stem from non-standardized ordering processes and a lack of knowledge among healthcare providers.<br /><br />A study surveyed 125 healthcare providers across the VA to understand current practices. Results showed that while oncologists order most biomarker tests, a significant portion is conducted by external laboratories. A key finding is the inconsistency in testing policies, with only a small percentage of facilities implementing reflex testing—a process where pathologists automatically initiate testing. Most respondents agree that results should be ready for the first oncology visit and support adopting reflex testing policies to improve efficiency.<br /><br />Barriers identified include a shortage of staff and resources, with pulmonologists often relying on oncologists to order tests. The article suggests that harmonized policies, like reflex testing, could alleviate these challenges by initiating testing as soon as a diagnosis is made, thus streamlining the process and ensuring timely treatment. While reflex testing supports efficient biomarker analysis, it currently sees limited application.<br /><br />The study highlights the discrepancies between needs and practices in biomarker testing within the VA, emphasizing the potential benefits of reflex testing and collaborative policies. It calls for broader implementation of such practices to ensure patients receive optimal precision oncology treatments. Despite the insights offered, the study notes limitations like low response rate and variable survey completion, yet it remains a crucial evaluation within the largest U.S. health system.

Keywords

biomarker testing

non-small cell lung cancer

Veterans Health Administration

precision medicine

reflex testing

oncology treatment

healthcare providers

testing policies

underutilization

collaborative policies