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An NLP tool to identify molecular diagnostic testing in veterans with stage IV NSCLC.

Publication ,  Conference
Lynch, JA; Kelley, MJ; Lee, KM; Hung, A; Li, Y; Hintze, BJ; Pendergraft, T; Pavilack, M; Efimova, O; DuVall, SL; Reed, SD
Published in: Journal of Clinical Oncology
September 20, 2019

318 Background: ASCO Quality Oncology Practice Initiative (QOPI) encourages hospitals to determine if patients (pts) with stage IV NSCLC adenocarcinoma have activating EGFR mutations. Guidelines recommend tumor testing to identify ALK, BRAF, EGFR, ROS1 and other gene alterations before treatment. Studies have shown EGFR testing underutilization. We developed and tested a tool to identify EGFR tests in Veterans Affairs (VA) electronic health record (EHR). We examined whether Veterans with newly diagnosed NSCLC-IV underwent EGFR testing. We measured EGFR testing trends and analyzed differences by patient, VA Medical Center (VAMC) and region. Methods: VA EHR data identified Veterans with NSCLC-IV diagnosed 2013-2017, who survived 45+ days and had 2+ visits with a VA oncologist within 120 days of diagnosis. All NSCLC histologies were included. Demographics and VAMC were obtained from VA Corporate Data Warehouse. EGFR testing results performed outside VA were from commercial laboratory data. We deployed a natural language processing (NLP) tool to identify EGFR tests in VA EHR clinical notes. Testing rates and characteristics associated with testing were examined by descriptive analysis. Results: Of 3484 pts, 623 (18%) had evidence of EGFR testing. There was a 244% rise in testing. 54 (9%) pts diagnosed in 2013 were tested vs 186 (25%) diagnosed in 2017 ( χ 82.3, p-value 0.00). No statistically significant differences by sex, race, or urban/rural address existed. Testing decreased as pts aged ( χ 27, p-value 0.00). 35% of pts age ≤49 and 12% of pts age ≥80 were tested. Testing varied widely by VAMC and region (VAMC χ 795.6, p-value 0.00; region χ 90.3, p-value 0.00). 28% of pts in the Pacific were tested vs 10% of pts in the Southeast. The main contributor to regional variation was VAMC differences. VAMCs that conducted EGFR testing within their own laboratories (64% and 53%), or were co-located with the national precision oncology program (NPOP, 59%) tested the most pts. NPOP was temporally associated with increased testing nationally. 9% of pts diagnosed in 2017 were tested using NPOP. Conclusions: EGFR testing underutilization in the VA persists. QOPI and the NLP tool for this initiative will help system-wide quality improvement initiatives.

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Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

September 20, 2019

Volume

37

Issue

27_suppl

Start / End Page

318 / 318

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lynch, J. A., Kelley, M. J., Lee, K. M., Hung, A., Li, Y., Hintze, B. J., … Reed, S. D. (2019). An NLP tool to identify molecular diagnostic testing in veterans with stage IV NSCLC. In Journal of Clinical Oncology (Vol. 37, pp. 318–318). American Society of Clinical Oncology (ASCO). https://doi.org/10.1200/jco.2019.37.27_suppl.318
Lynch, Julie Ann, Michael J. Kelley, Kyung Min Lee, Anna Hung, Yanhong Li, Bradley J. Hintze, Trudy Pendergraft, et al. “An NLP tool to identify molecular diagnostic testing in veterans with stage IV NSCLC.” In Journal of Clinical Oncology, 37:318–318. American Society of Clinical Oncology (ASCO), 2019. https://doi.org/10.1200/jco.2019.37.27_suppl.318.
Lynch JA, Kelley MJ, Lee KM, Hung A, Li Y, Hintze BJ, et al. An NLP tool to identify molecular diagnostic testing in veterans with stage IV NSCLC. In: Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2019. p. 318–318.
Lynch, Julie Ann, et al. “An NLP tool to identify molecular diagnostic testing in veterans with stage IV NSCLC.Journal of Clinical Oncology, vol. 37, no. 27_suppl, American Society of Clinical Oncology (ASCO), 2019, pp. 318–318. Crossref, doi:10.1200/jco.2019.37.27_suppl.318.
Lynch JA, Kelley MJ, Lee KM, Hung A, Li Y, Hintze BJ, Pendergraft T, Pavilack M, Efimova O, DuVall SL, Reed SD. An NLP tool to identify molecular diagnostic testing in veterans with stage IV NSCLC. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2019. p. 318–318.

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

September 20, 2019

Volume

37

Issue

27_suppl

Start / End Page

318 / 318

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences