41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists

41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists

Background/Significance

The 2023 ASCO-CAP guideline update emphasized accurate HER2 testing and reporting for HER2-low metastatic breast cancer. This study seeks to better understand providers’ (oncologists’ and pathologists’) perceptions and practices for HER2 testing in the community setting and characterize facilitators and barriers to HER2 testing, documentation, and treatment.

Materials and Methods

A web-based survey was developed using Qualtrics software with inputs from subject matter experts; the survey was piloted and deployed (February 26, 2024, to May 8, 2024) to US community-based pathologists and oncologists who test or treat patients with breast cancer within the Guardian Research Network or IQVIA’s health care professionals panel to assess preferences and practices for HER2 testing. A self-selected subset of respondents participated in semistructured 1:1 virtual interviews to contextualize their survey responses. Providers were compensated for their time. Responses were analyzed using MAXQDA.

Results

There were 63 survey responses (to 100+ invitations) and 27 interviews among US community-based pathologists (31 surveys, 14 interviews) and oncologists (32 surveys, 13 interviews). While most pathologists (93%) report discrete immunohistochemistry (IHC) scoring on pathology reports, 20% do not distinguish IHC 0 and IHC 1+, and 32% do not report percentage staining. Barriers to discrete IHC reporting were background staining, poor interpretation standards, and staining variability. Increased interpretation time and workflow disruptions were barriers to reporting percentage staining, and pathologists were awaiting further evidence of clinical utility. Both pathologists and oncologists agreed that oncologists’ requests drive testing changes. Oncologists report lack of reimbursement of tests and treatment as major barriers to treatment decision-making for HER2-directed therapies. Digital pathology (digital imaging/scanning, scoring algorithms, and other tools) was viewed favorably by oncologists (92%) and by pathologists (50%), with improved accuracy, efficiency, and reduced subjectivity as advantages, and high costs and lack of practice standards as barriers to adoption.

Conclusion

These findings characterize community providers’ preferences and practices for HER2 IHC testing results and treatment for metastatic breast cancer patients. While innovative testing tools are viewed favorably, cost and need for additional training are barriers to broader adoption.