When it comes to treating advanced non-small cell lung cancer (NSCLC), providing the appropriate treatment via biomarker testing is vital. Even more vital? Doing it quickly.
And yet, all too often, delays in biomarker testing waste precious time that could make the difference between life or death. Reducing those delays is the mission of Adam Fox, MD, MS, a pulmonologist specializing in thoracic oncology and an assistant professor at the Medical University of South Carolina.
In 2023, he was awarded a CHEST grant to create a quality improvement project to make sure recommended biomarker testing checklists were being implemented efficiently.
“Stage four lung cancer kills quickly. Roughly 40% of people die within 90 days,” he said. “Sometimes testing is merely delayed; but, in many cases, we find that it's just not happening at all for one reason or another, and the patient dies.”
One of the biggest issues is communication difficulties among subspecialties, which can involve pathologists, oncologists, pulmonologists, radiologists, and others, Dr. Fox said. Ideally, as soon as lung cancer is diagnosed, reflex testing is the next step, which means biomarker testing happens almost immediately.
To address the testing delays, his project had four goals: create measurable metrics for biomarker testing; improve communication among medical teams; implement reflex biomarker testing, and make it centralized and standardized; and educate clinicians, patients, and others about the importance of rapid testing.
Throughout the project, which wrapped up at the end of 2024, the team also used process improvement methods like case reviews to make sure the project was working. One remarkably useful but simple step was establishing a Microsoft Teams channel that includes multiple medical specialists so they can collectively discuss individual cases.
While he’s still gathering data on the project, early signs indicate success of the intervention with rapid ordering for nearly all patients at his facility.
Dr. Fox credits the CHEST quality improvement grant with giving him the time and tools to collaborate with his own institution and bring different groups together. He’s also been able to publish several peer-reviewed papers in the journal CHEST®, which help medical teams across the country learn how to improve biomarker testing outcomes at their own facilities:
His next goal is to take this effort to community hospitals that aren’t connected with large university systems, where many medical teams are housed together. A 2024 career development grant from the American Cancer Society will allow him to pursue that project.
Most patients get diagnosed and treated in community settings, so it's an especially important avenue to explore, he explained.
“My goal is for all patients to get appropriate testing and treatment options,” he said. “That's really the whole crux of my work going forward: How do we take this from single-center academic sites, which often have testing in-house, and move it to community centers that have different resources and different barriers to testing?”