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

Testing for mutation of the (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 results, a few centres implemented reflex testing, defined as a request for testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on testing rates. 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 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). The 7 included centres had requested tests for 2214 patients. The proportion of pathologists requesting tests increased after implementation of reflex testing (53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased (46% vs. 95%, < 0.001). After implementation of reflex testing, the mean number of patients having testing per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5-14.9), < 0.001]. Before reflex testing, testing rates showed a significant monthly increase over time (1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in test requests was observed with the introduction of reflex testing ( = 0.003), and the overall trend was sustained throughout the post-reflex testing period ( < 0.001). Reflex testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in testing.