Patient Engagement Can Help Drive More Comprehensive NSCLC Testing: Julia Rotow, MD

In part 2 of an interview with The American Journal of Managed Care®, Julia Rotow, MD, Dana-Farber Cancer Institute, discusses how the definition of comprehensive testing in non-small cell lung cancer (NSCLC) continues to evolve amid emerging biomarkers and therapies, noting that this challenge is further amplified in community practices.

This conversation builds on insights from the recent Institute for Value-Based Medicine regional event in Boston, where she moderated the panel, "Value-Driven Precision: Advancing Equitable Access to Targeted and Immuno-Oncology Therapies in Lung Cancer."

Watch part 1 of the interview to hear Rotow explain the variation in precision medicine uptake for NSCLC and the critical need for biomarker testing in this patient population.

This transcript has been lightly edited; captions are auto-generated.

Transcript

During the panel, you mentioned the difficulty of maintaining comprehensive lung cancer testing amid emerging targets and evolving treatments. How are these challenges amplified in community practices compared with academic centers?

Another challenge, although also an opportunity, [which is] exciting about the field of managing non-small cell lung cancer, has been about the evolution of available therapies over time. We keep adding to the list of things that are possible, adding to the list of things that are actionable, on genomic testing or on biomarker testing for our patients. That does mean, though, that what it means to have comprehensive profiling, the definition of that, has changed over the years, and what was comprehensive, say, 2 or 3 years ago might not be comprehensive today.

That's a challenge for every oncologist, I think, including myself. When we're seeing patients and we're thinking about what's available now as a therapy, we can't just look back to our notes and say negative testing or no actual findings, but is there still nothing actionable today? I always do a look back at each line of therapy, just double-checking: are my biomarkers still up-to-date? Have I missed one that I could send now that's newly actionable, that I can add into my patient's profile?

Even for a thoracic oncologist, that requires a very active and ongoing effort, longitudinally, over a patient's care to make sure that their testing remains up-to-date over time. That challenge is amplified in a community setting, a more general oncology setting, where, of course, now they're not just worrying about being up-to-date in thoracic oncology, but they have to be up-to-date across biomarkers and relevant therapies, across all disease settings. Of course, ongoing education and ongoing access to [continuing medical education] are critical, and I think knowledge and awareness of the evolution of the field over time become really essential.

It's also an area where, frankly, patients and patient advocates, I think, can be really helpful. It's a great question for a patient to ask their oncologist as they're thinking about changing therapy: is there anything new? Is there any new biomarker? Is there a new test that we should be sending? It can tip the oncologist off to think, "Wait, let me just take a look back again." It helps cue that review. I really want to encourage the empowerment of patients to ask questions and be an active participant in care as well, because it really can help make a difference.