Abstract
Background: Lung cancer remains a leading cause of cancer mortality globally. In New Zealand (NZ), lung cancer disproportionately affects our indigenous Māori population with both incidence and mortality being three times higher than NZ-Europeans. Incidence of endothelial growth factor receptor mutated lung cancer is two to three times higher in Māori, Pacific, and Asian people compared to NZ-Europeans. Diagnostic delays arise from tissue biopsy difficulties and a lack of standardization in molecular testing. These delays could potentially be reduced if testing was augmented by liquid biopsy (LB) at the outset of diagnosis. LB could be more accessible, faster, and lower cost compared to tissue biopsy. We aimed to evaluate primary health clinicians’ (PHCs’) attitudes towards use of LB for molecular testing and lung cancer diagnosis.
Methods: A NZ national survey was conducted of PHCs. The online survey was distributed through PHC bulletins, newsletters, and social media. It was open to circulation between November 2023 to January 2024 and consenting clinicians completed this via REDCap. Descriptive analysis was performed and reported in aggregate.
Results: Seventy-two PHCs responded with 58 complete responses. Respondents were 78% urban and 25% worked in practices of very low-cost access. Current diagnostic challenges reported include limited PHC appointments, poor access to imaging, and limited access to specialist care. Fast track diagnostic pathway to specialist care existed for 55% of respondents. 92% were initially unaware of LB for molecular testing. 79% were not comfortable with pre-test genetic counselling associated for this. Concerns raised about LB included subsequent patient access to secondary care and establishing a culturally appropriate pathway particularly for Māori. Some rural PHCs highlighted the potential of LB to complement existing procedures. Provided there were adequate training and funding for LB, 72% of respondents would be comfortable requesting LB and associated counselling. The most preferred types of training were PHC focused articles (70%), online clinical pathways (68%), webinar (61%), online course (51%), and in-person presentation (46%).
Conclusions: Most PHCs were not familiar with LB for molecular testing but 72% supported these tests to be incorporated into current pathways. There is a need to develop culturally safe pathways with sufficient training and funding, in order to reduce health inequities.