title: Rate ofEGFRmutation testing for patients with nonsquamous non-small-cell lung cancer with implementation of reflex testing by pathologists.
abstract: BACKGROUND
  Testing for mutation of theEGFR(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 toEGFRresults, a few centres implemented reflex testing, defined as a request forEGFRtesting by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing onEGFRtesting 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 requestedEGFRtesting 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 requestedEGFRtests for 2214 patients. The proportion of pathologists requestingEGFRtests 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 havingEGFRtesting per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5-14.9),p< 0.001]. Before reflex testing,EGFRtesting 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 inEGFRtest 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
  ReflexEGFRtesting for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase inEGFRtesting.
authors.affiliation: Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto.
authors.forename: P K
authors.initials: PK
authors.lastname: Cheema
authors.affiliation: Department of Anatomic Pathology, North York General Hospital, Toronto.
authors.forename: S
authors.initials: S
authors.lastname: Raphael
authors.affiliation: Department of Medical Oncology/Hematology, Royal Victoria Regional Health Centre, Barrie.
authors.forename: R
authors.initials: R
authors.lastname: El-Maraghi
authors.affiliation: Department of Medical Oncology/Hematology, Michael Garron Hospital, Toronto.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Anatomic Pathology, Health Sciences North, Sudbury.
authors.forename: R
authors.initials: R
authors.lastname: McClure
authors.affiliation: Department of Medical Oncology/Hematology, Southlake Regional Health Centre, Newmarket.
authors.forename: L
authors.initials: L
authors.lastname: Zibdawi
authors.affiliation: Department of Medical Oncology/Hematology, Thunder Bay Regional Health Sciences Centre, Thunder Bay.
authors.forename: A
authors.initials: A
authors.lastname: Chan
authors.affiliation: Institute of Health Policy Management and Evaluation, University of Toronto, Toronto; and.
authors.forename: J C
authors.initials: JC
authors.lastname: Victor
authors.affiliation: AstraZeneca Canada Inc., Mississauga, ON.
authors.forename: A
authors.initials: A
authors.lastname: Dolley
authors.affiliation: AstraZeneca Canada Inc., Mississauga, ON.
authors.forename: A
authors.initials: A
authors.lastname: Dziarmaga
keywords: EGFR; Reflex testing; biomarkers; non-small-cell lung cancer