PURPOSE With the introduction of precision medicine, treatment options for non-small-cell lung cancer have improved dramatically; however, underutilization, especially in disadvantaged patients, like those living in rural Appalachian regions, is associated with poorer survival. Molecular tumor boards (MTBs) represent a strategy to increase precision medicine use. UK HealthCare at the University of Kentucky (UK) implemented a statewide MTB in January 2017. We wanted to test the impact of UK MTB review on overall survival in Appalachian and other regions in Kentucky. METHODS We performed a case-control study of Kentucky patients newly diagnosed with non-small-cell lung cancer between 2017 and 2019. Cases were reviewed by the UK MTB and were compared with controls without UK MTB review. Controls were identified from the Kentucky Cancer Registry and propensity-matched to cases. The primary end point was the association between MTB review and overall patient survival. RESULTS Overall, 956 patients were included, with 343 (39%) residing in an Appalachian region. Seventy-seven (8.1%) were reviewed by the MTB and classified as cases. Cox regression analysis showed that poorer survival outcome was associated with lack of MTB review (hazard ratio [HR] = 8.61; 95% CI, 3.83 to 19.31; P,.0001) and living in an Appalachian region (hazard ratio = 1.43; 95% CI, 1.17 to 1.75; P =.004). Among individuals with MTB review, survival outcomes were similar regardless of whether they lived in Appalachia or other parts of Kentucky. CONCLUSION MTB review is an independent positive predictor of overall survival regardless of residence location. MTBs may help overcome some health disparities for disadvantaged populations.
|Number of pages
|JCO Precision Oncology
|Published - 2021
Bibliographical noteFunding Information:
The Markey Cancer Center's Research Communications Office assisted with manuscript preparation. The authors collaborated with faculty and staff in the Biostatistics and Bioinformatics Shared Resource Facility and the Cancer Research Informatics Shared Resource Facility. B. Mark Evers, Robert DiPaola, and Lee Vermeulen are acknowledged for helpful discussions.
Supported by the National Cancer Institute at the National Institutes of Health including support for the Biostatistics and Bioinformatics Shared Resource Facility and the Cancer Research Informatics Shared Resource Facilities of the University of Kentucky Markey Cancer Center (P30CA177558, B.M.E.).
© 2021 by American Society of Clinical Oncology Creative Commons Attribution Non-Commercial No Derivatives 4.0 License
ASJC Scopus subject areas
- Cancer Research