Next-generation sequencing (NGS) is a crucial component of evaluation of patients with newly diagnosed metastatic non–small-cell lung cancer (NSCLC) to determine appropriate first-line treatment. This quality improvement project aimed to reduce time to NGS results in patients with metastatic NSCLC.

We reviewed electronic medical records of patients with newly diagnosed, untreated metastatic NSCLC from December 2018 to August 2021 and determined the number of days from pathologic diagnosis to NGS results. We reviewed process maps for oncology, pathology, the Division of Research, and a NGS vendor to determine factors leading to preventable delays. Since November 2020, we created an automated, electronic weekly report to provide earlier identification of new pathologic diagnoses in patients with metastatic NSCLC. On June 2021, we worked with our NGS vendors to expand days of the week to accept specimens.

Our interventions reduced the median time from pathologic diagnosis to NGS results from 24 (standard deviation [SD] 9) to 16 (SD 6) days. The median time from biopsy results to NGS order was reduced from 7 days to 1 day. The time from the specimen being sent from pathology to the NGS vendor was a median of 6 days in both cohorts. The total time from pathologic diagnosis to appropriate treatment was reduced from 33 (SD 18) to 22 (SD 8) days.

NGS processing in a community setting can be complex. Using a systems focused approach to quality improvement is crucial in identifying the greatest barriers in an organization. We found that delays in time to NGS results can be reduced by improved communication and workflows among departments.

Supported by the Kaiser Permanente Northern California Graduate Medical Education Program, Kaiser Foundation Hospitals.

Conception and design: Stephanie Ossowski, Elad Neeman, Charles Borden, Dinesh Kotak, Sachdev Thomas, J. Marie Suga, Amy Lin, Raymond Liu

Administrative support: Sachdev Thomas

Collection and assembly of data: Stephanie Ossowski, Douglas Stram, Lucy Giraldo, Amy Lin, Raymond Liu

Data analysis and interpretation: Stephanie Ossowski, Elad Neeman, Charles Borden, Douglas Stram, Lucy Giraldo, J. Marie Suga, Amy Lin, Raymond Liu

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Improving Time to Molecular Testing Results in Patients With Newly Diagnosed, Metastatic Non–Small-Cell Lung Cancer

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Raymond Liu

Research Funding: Genentech, AstraZeneca

No other potential conflicts of interest were reported.