Variation in EGFR testing for patients with stage IB or higher lung cancer in the United States.

AIM: Current guidelines recommend that all patients with stage IB or higher lung adenocarcinoma undergo Epidermal Growth Factor Receptor (EGFR) testing. In this study, we investigate the hospital-level variation of EGFR testing nationally.

METHODS

We identified patients with stage IB or higher lung adenocarcinoma between 2021-2022 from a national hospital-based dataset. We used hierarchical multivariable regression modeling to adjust for patient-, tumor- and hospital-characteristics and calculate adjusted EGFR testing rates. We grouped hospitals into quintiles for comparison, and Kaplan-Meier analyses to estimate survival.

RESULTS

Only 40,434 (43.4%) of 93,158 patients with stage IB or higher adenocarcinoma at 1,277 hospitals were tested for EGFR mutations. Independent predictors of EGFR testing included female sex (aOR = 1.15), tumor stage (Stage IV vs IB aOR = 1.41) and higher median income (aOR = 1.21;all p < 0.001). Hospitals in the lowest quintile had adjusted testing rates of 13.3% vs 70.3% in the highest quintile (p < 0.001). Hospitals with the highest EGFR testing rates had better overall survival (p < 0.001).

CONCLUSION

Contrary to current guidelines, most patients with stage IB adenocarcinoma or higher are not receiving EGFR testing. Patients treated at hospitals with higher testing rates were associated with better survival, although this is likely multifactorial. Quality improvement efforts should target centers for guideline-concordant care.