A Performance and Quality Improvement Intervention Integrating Molecular Testing to Support Personalized Cancer Care in Lung and Thyroid Cancers

Authors

• Suzanne Murray, AXDEV Group Inc.Follow
• Monica Augustyniak, AXDEV Group Inc.Follow
• John Vu, Baptist Hospital, FloridaFollow
• Elbert Y. Kuo, Baptist Hospital, FloridaFollow
• Manolo G. Pasia Jr., The University of Texas MD Anderson Cancer CenterFollow
• Sheri L. Rivera, The University of Texas MD Anderson Cancer CenterFollow
• Kelly M. Rodriguez, The University of Texas MD Anderson Cancer CenterFollow
• Vivek Subbiah, Sarah Cannon Research InstituteFollow
• Patrice Lazure, AXDEV Group Inc.Follow
• Ecaterina E. Dumbrava, The University of Texas MD Anderson Cancer CenterFollow

Document Type

Article

Abstract

Introduction: Molecular testing has been underutilized in the diagnosis and treatment of cancer patients, despite its potential to significantly impact clinical decision-making and resulting health outcomes.

Objectives: This project aimed to evaluate the process and impact of a performance/quality improvement (PI/QI) intervention to optimize the integration of molecular testing for patients with non-small cell lung cancer (NSCLC) or thyroid cancer (TC).

Methods: Physicians, advanced practice providers, and nurses were engaged in the PI/QI at 2 cancer centers (Site A and Site B) for up to 18 months following a pre-intervention needs assessment. Gaps identified at baseline informed the design and deployment of the PI/QI intervention. It included 4 faculty-led interactive webinars focused on evidence regarding molecular testing in NSCLC or TC, best practice guidelines, and the development of action plans among participants. Between and after sessions, participants implemented their action plans to optimize integration of molecular testing for NSCLC/TC. A longitudinal, mixed-methods evaluation was performed to measure outcomes and impact via PI/QI metrics before, during, and after the intervention. Data sources included electronic medical records (EMR), questionnaires, and qualitative interviews.

Results: Site A’s EMR baseline data (n = 295 NSCLC; n = 7 TC) showed 84% (254) of all patients had single-gene mutation or immunohistochemistry testing ordered. However, only 59% (177) had comprehensive next-generation sequencing (NGS) on a large gene panel. Thus, Site A’s action plans focused on optimizing NGS testing. Site B’s EMR baseline data (n = 112 NSCLC; n = 3 TC) showed 75% (86) had molecular testing ordered, and 33% (38) had NGS. Therefore, Site B’s action plans aimed to increase all types of molecular testing. Both sites worked on optimizing workflows to offer comprehensive molecular tests for personalized treatment. After 18 months, Site A’s EMR showed an increase in NGS tests ordered to 76% (73 of 96 patients; +17% absolute increase). After 6 months, Site B’s EMR showed increases of all molecular tests ordered to 83% (69 of 83 patients; +8% absolute increase) and 45% NGS tests ordered (37 of 83; +12% absolute increase). Participants articulated how they addressed limited resources and time constraints, notably in new roles and responsibilities for improved coordination of care.

Conclusions: The PI/QI intervention enabled health care teams at both sites to achieve targeted changes in molecular testing, despite a busy clinical environment. These findings can serve other cancer centers aiming to increase molecular testing integration within their teams and institution.

Grants and Funding

This activity is supported by an educational grant from Eli Lilly USA (Grant A-29694). All components of this initiative were conducted independently from the funders, who were kept informed of the progress and able to review associated deliverables (including this manuscript) but were not involved in any decision-making regarding the design, deployment and interpretation of this research and its dissemination.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Recommended Citation

Murray S, Augustyniak M, Vu J, Kuo EY, Pasia MG, Rivera SL, Rodriguez KM, Subbiah V, Lazure P, Dumbrava EE. A Performance and Quality Improvement Intervention Integrating Molecular Testing to Support Personalized Cancer Care in Lung and Thyroid Cancers. Advances in Cancer Education and Quality Improvement. 2026; 2(1).