Gregory Vidal, MD, PhD, Breast Medical Oncologist, West Cancer Center, Germantown, TN, spoke with the Journal of Clinical Pathways at the ASCO 2023 Annual Meeting about his study on inequities in next-generation sequencing testing by race/ethnicity for patients with advanced non–small cell lung cancer treated in the community setting.

Transcript:

Gregory  Vidal, MD, PhD: My name is Gregory Vidal. I am a breast medical oncologist at the West Cancer Center and Research Institute. I co-direct the clinical research, and I'm also the chair of the breast group at One Oncology.

Can you give some background about your study and what prompted you to undertake it?

Dr Vidal: So NGS and molecular profile is becoming standard in oncology. Most of our drugs that are now being approved have a biomarker association. We know NGS testing and targeting NGS has survival benefit for many patients. In lung in particular, this tumor type has become such a biomarker driven tumor that knowing what the biomarkers are is absolutely important for drug selection and survival. So one of the things that we were interested in is figuring out, one, in the lung space, are we getting the testing that we require? But not only that is one group of patients being affected more than the other? We do know that there's disparities in availability and testing for black or minority patients versus white patients. We wanted to get an idea of what is the scope of the problem in a community setting. But even more than that on a holistic approach where the problem is. Is it at the practice level? Is it at the physician level? Because then once we start finding solutions, we need to know directly where to go to get those solutions.

Can you briefly describe how the study was conducted?

Dr Vidal: So the study was a retrospective study where we went back and looked at, I think about 250 cancer centers, about 800 I think different practices, and selected a population of patients who met our criteria, meaning they had to have lung cancer, they had to have NGS testing. It was a very sort of broad inclusion criteria. Patients were excluded if they were being treated in more than one site, for example. And the exclusion criteria was also very narrow. But we ended up screening over 70,000 patients and about 14,000 patients ended up being included in our study, 9,000 of which were, a little above 9,000 were non-Latinx White, otherwise known as white patients. About 1500 were non-Latinx Black or Black patients. And then a little above 500 were Latinx patients. And then we did the analysis on that population.

What were the key findings of your study?

Dr Vidal: So the key findings were that, so we looked at to see if the issue was a practice issue. So we looked at what we call within practice. Are there issues going on within the practice that leads to this disparity? Is it one practice doing better than the other one? And then even physicians looking at physicians themselves. Is one physician within a practice the issue versus another one, or the physician himself is making a decision to treat one patient different than the other one? So the key findings are that from a practice perspective, we noticed that the issue was both, again, this was a holistic approach to look at. The issue was both practice, within practice and across practice, but the most surprising thing to me, at least personally, was on a provider level.

What we noticed on a provider level is that we saw less of the problem being a provider treating his patient differently, and more that the difference is between providers, patients of color, Latinx or Black tended to see physicians who generally don't do a lot of testing or go to practices that don't do a lot of testing, which was a surprise to me because I thought there may have been some bias in the provider. So those were the sort of main findings associated with it. We definitely saw that there was a disparity, about an 8% difference between in terms of testing for patients who are White versus Latinx or Black.

Looking ahead, what potential impact do you hope your findings will have on addressing inequities in NGS testing?

Dr Vidal: So at least from this study, it gives us an area to look at. If we're going to get a solution to this problem, we need to know where to look. So from the provider level perspective, for example. Those physicians who do not test a lot, we need to focus on them. Why don't you test and educate the practices who don't test a lot. Go to them, educate. But more than that, this is not the completion of the study. We need, even within practices, we need to figure out why. And so the next iteration of this is trying to figure out why this is happening, what are the other factors? So we didn't exclude, or the study was not conducted on sort of a minute level, meaning socioeconomic status and insurance status. We didn't remove those and we didn't consider those because we think those also impact everything because there was a more holistic approach. But we need to then go in and look and see whether these insurance, socioeconomic status, location, whether those also impact because ultimately we need to figure out what is the issue and then start to address them with some solutions.

Is there anything else you would like to add?

Dr Vidal: This sort of work is very helpful. The data is available, but more than anything else, it allows us, we know that there's a problem. The problem has always existed. There's disparity in care in oncology particularly, but it happens in all of medicine. And I am very happy for studies like this, and many of the other studies that are going on, that are trying to figure out what the problem is and trying to address it so that every patient, at least in the United States and hopefully this gets translated outside of the United States, get very good equal care and hopefully very similar outcomes.