Understanding Factors Associated With Anaplastic Lymphoma Kinase Testing Delays in Patients With Non–Small Cell Lung Cancer in a Large Real-World Oncology Database

Context.— With multiple therapeutic options available for patients with advanced non–small cell lung cancer, the timely ordering and return of results to determine therapy are of critical importance. Objective.— To assess factors impacting anaplastic lymphoma kinase (ALK) test ordering and time to result delivery. Design.— A retrospective study using a de-identified electronic health record database was performed. Postdiagnosis ALK tests (n = 14 657) were analyzed from 14 197 patients with advanced non–small cell lung cancer diagnosed between January 2015 and May 2019. Time from non–small cell lung cancer diagnosis to ALK sample receipt in the laboratory was a surrogate for test order time. Test ordering was considered delayed if order time was more than 20 days. Turnaround time from sample received to test result was calculated and considered delayed if more than 10 days. Multivariable logistic regression was used to assess factors associated with order time and turnaround time delays. Results.— Median ALK test order time was 15 days, and 36.4% (5342) of all 14 657 orders were delayed. Factors associated with delays were non–fluorescent in situ hybridization testing, send-out laboratories, testing prior to 2018, nonadenocarcinoma histology, and smoking history. Median turnaround time was 9 days, and 40.3% (5906) of all 14 657 test results were delayed. Non–fluorescent in situ hybridization testing, tissue sample, and orders combining ALK with other biomarkers were associated with delayed ALK result reporting. Conclusions.— This study provides a snapshot of real-world ALK test ordering and reporting time in US community practices. Multiple factors impacted both test ordering time and return of results, revealing opportunities for improvement. It is imperative that patients eligible for targeted therapy be identified in a timely fashion.