Nurse Navigation, Reflex Testing Key to Closing Molecular Testing Gaps: Christopher D'Avella, MD

Christopher A. D’Avella, MD, a thoracic oncologist at the University of Pennsylvania, highlighted persistent equity gaps in molecular testing for lung cancer, emphasizing that underserved populations, particularly African American patients, continue to experience lower testing rates, largely driven by barriers in access to care. In an interview at The American Journal of Managed Care^® Institute for Value-Based Medicine® event in Philadelphia on April 10, he explained that while reflex testing can significantly improve timely diagnosis and treatment, its effectiveness depends on patients being connected to well-coordinated, multidisciplinary care teams. This includes access to medical oncologists, biopsy services, and specialists such as surgeons and radiation oncologists—resources that are not uniformly available across care settings.

Delays in care remain a critical issue. D’Avella, who also serves as section chief of hematology/oncology at Penn Presbyterian Medical Center, codirector of Cancer Diagnostics Clinic, and assistant professor of clinical medicine, noted that some patients undergo initial biopsies at one facility but do not receive appropriate follow-up until weeks later at another center, resulting in lost time that can impact outcomes. To address this, he underscored the importance of nurse navigation as a central solution. Nurse navigators can triage patients based on urgency, coordinate diagnostic testing, and ensure timely progression through the care pathway.

From an infrastructure standpoint, disparities are compounded by uneven resource distribution. While ideal cancer programs would incorporate reflex testing, multidisciplinary care, and navigation services, many lack the capacity to do so. D’Avella pointed to growing interest from policymakers, including CMS, in promoting guideline-concordant care, though gaps remain.

Reimbursement challenges also contribute to inequities. Although molecular testing is generally covered, inconsistencies in claims, particularly among private insurers, and emerging complexities around liquid biopsies can create financial barriers. D’Avella called for stronger policy action to ensure comprehensive and consistent coverage.

Finally, he emphasized the increasing complexity of oncology care, particularly in lung cancer, where rapidly evolving research and treatment options can be difficult for generalists to keep pace with. He stressed that continued education, community partnerships, and expanded access to expertise will be essential to improving patient outcomes.