Rate of EGFR mutation testing for patients with nonsquamous non-small-cell lung cancer with implementation of reflex testing by pathologists

Background Testing for mutation of the EGFR ( epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non- small- cell lung cancer ( nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request for EGFR testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on EGFR testing rates. Methods A retrospective observational review of the Web- based AstraZeneca Canada EGFR Database from 1 April 2010 to 31 March 2014 found centres within Ontario that had requested EGFR testing through the database and that had implemented reflex testing ( with at least 2 years' worth of data, including the pre- and post- implementation period). Results The 7 included centres had requested EGFR tests for 2214 patients. The proportion of pathologists requesting EGFR tests increased after implementation of reflex testing ( 53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased ( 46% vs. 95%, p < 0.001). After implementation of reflex testing, the mean number of patients having EGFR testing per centre per month increased significantly [ 12.6 vs. 4.9 ( range: 4.5- 14.9), p < 0.001]. Before reflex testing, EGFR testing rates showed a significant monthly increase over time ( 1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; p < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing ( p = 0.003), and the overall trend was sustained throughout the post- reflex testing period ( p < 0.001). Conclusions Reflex EGFR testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in EGFR testing.