Date of Award

January 2016

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Fatma M. Shebl

Abstract

Introduction

All patients with metastatic non-small cell lung cancer (NSCLC) should undergo EGFR mutation testing and receive appropriate therapy, however, variation in testing and therapy use is a growing concern. The objective of this investigation was to identify physicians’ practice patterns and predictors of physicians’ genetic testing and targeted therapy use in metastatic lung cancer.

Methods

Approximately 360 physicians caring for CanCORS patients with lung or colorectal cancer completed a survey between 2012 to 2013 assessing attitudes and practices with respect to genetic testing and targeted therapies. The outcome variables were: (1) physicians’ reports that they would likely recommend (a) EGFR testing and (b) ERCC1 testing for a hypothetical patient; (2) physicians’ reports that they would choose Erlotinib as first-line regimen if a patient was found to have an EGFR mutation.

Results

Physicians who often obtained information from peer-reviewed medical literature reported that they would recommend EGFR testing more than those who rarely/never used this source (p=0.068). Physicians who were younger, had fewer years since graduation from medical school, graduated from a U.S./Canadian school, and were Asian or White chose Erlotinib more than physicians without these features (p=0.008, p=0.011, p=0.068, and p=0.021). Physicians who reported local/national guidelines as having a high impact on their test use, and those who reported obtaining information often from local colleagues, national/international experts, or national guidelines, chose Erlotinib more than their counterparts (p=0.066, p=0.062, p=0.037, and p=0.041). Those with solo practice types were the least likely to recommend Erlotinib compared to other practice types (p=0.013). After adjustment, gender, age, race, practice type, impact of national guidelines, and obtaining information from national/international experts all remained significantly associated with choice of Erlotinib (OR[CI]=2.07 [1.12, 3.81] and OR[CI]=1.56 [0.96, 2.52], respectfully).

Conclusion

It can be inferred that the variation seen in testing and treatment in patients with NSCLC is largely due to the differences in physicians’ knowledge, which are the result of diverse sources of information. The implications that follow the findings of the present paper include: the importance of considering the content and format of reports and guidelines directed towards clinicians; and the need for easily accessible interfaces that provide the knowledge and support for clinical decision-making.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/07/2018

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