Precision medicine in NSCLC: Challenges and practice gaps in community cancer clinics.

8589 Background: Current guidelines for clinical management of advanced NSCLC recommend testing for nine molecular alterations in addition to PD-L1, to identify appropriate patients for targeted therapies. This quality improvement initiative evaluated current practice patterns in biomarker testing in NSCLC in community oncology clinics. Methods: In 2023, 68 healthcare providers (HCPs) from 6 clinics completed surveys on biomarker testing, treatment decision making, and patient-centered care in NSCLC. Teams from each clinic (N=98) then participated in audit/feedback (AF) sessions to assess site-specific gaps and develop and implement action plans for improvement. Results: Many advanced NSCLC patients did not receive the recommended biomarker tests (Table). This is likely related to low rates of next-generation sequencing (NGS) based testing: only 45% or 30% of patients received DNA-based or RNA-based NGS, respectively. Most HCPs (72%) reported testing at time of diagnosis, and about one-third also tested at time of disease progression. However, 48% of HCPs were very/extremely likely to start treatment before receiving molecular test results, and 49% said that "determining whether to begin treatment prior to receipt of molecular testing results" was their top challenge in NSCLC care. Rates of targeted therapy receipt were low, with 33% of HCPs reporting that fewer than half of their patients with an actionable mutation received the corresponding agent. Providers believed "improved collaboration across interprofessional teams" (24%) and "integration of multidisciplinary tumor boards into treatment planning" (22%) would most improve care for NSCLC patients. To address identified gaps, teams developed action plans, including establishing new workflows to better incorporate molecular testing and designating a team member to facilitate multidisciplinary collaboration. Following the AF session, providers reported high confidence in selecting appropriate biomarker tests (83%) and biomarker-directed therapies (75%) for patients with NSCLC . Full findings will be presented, along with follow-up surveys measuring real-world impact of the system-level practice changes. Conclusions: Although most HCPs used some form of molecular testing in NSCLC, testing was not as comprehensive as current guidelines recommend. Through this QI initiative, teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support effective and evidence-based integration of biomarker testing in advanced NSCLC to optimize patient outcomes that can help inform improvement strategies for NSCLC care teams in community settings nationwide. Table: see text