# General practitioners’ attitudes towards liquid biopsy as a diagnostic test for advanced lung cancer

## TL;DR

A survey of New Zealand general practitioners found most were unfamiliar with liquid biopsy, but many would support its use if properly trained and funded.

## Contribution

The study reveals GPs' attitudes toward liquid biopsy for lung cancer and highlights the need for education and funding to adopt this diagnostic method.

## Key findings

- Only 9% of surveyed GPs were aware of liquid biopsy for lung cancer.
- 72% of GPs would use liquid biopsy if trained and funded.
- Challenges include limited access to imaging and secondary care in rural areas.

## Abstract

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 (EGFR) mutated lung cancer is two to three times higher in Māori, Pacific and Asian people compared to NZ Europeans. Outcomes could potentially be improved if testing was augmented by biomarker testing of circulating tumour deoxyribonucleic acid (ctDNA) at the outset of diagnosis. Testing as a liquid biopsy could be more accessible, faster, and lower cost compared to tissue biopsy.

We aimed to evaluate NZ General Practitioners' (GPs’) attitudes towards liquid biopsy.

A survey was conducted of NZ GPs and was distributed through online channels between November 2023 to January 2024.

Seventy GPs responded and challenges reported with the diagnostic process of lung cancer were: limited GP appointments, poor access to imaging, and limited access to secondary care. 53/58 (91 %) of GPs were unaware of liquid biopsy. 46/58 (79 %) were initially not comfortable with pre-test genetic counselling associated for this. Some GPs highlighted the potential of liquid biopsy to complement existing procedures particularly in rural areas although concerns were expressed regarding culturally appropriate pathways. Provided adequate training and funding for liquid biopsy, 42/58 (72 %) of GPs stated they would be comfortable requesting liquid biopsy and the associated counselling.

Most GPs were not familiar with liquid biopsy but 72 % supported these tests to be incorporated into current pathways. Liquid biopsy could potentially reduce diagnostic delays and inequities in lung cancer.

•70 general practitioners were surveyed on using liquid biopsy to diagnose lung cancer.•Only 12 % & 9 % of those surveyed were aware of molecular testing and liquid biopsy.•39 % of those surveyed were familiar with molecularly targeted treatments.•72 % of those surveyed would use liquid biopsy to test circulating tumor DNA.•Education and funding are needed to apply liquid biopsy in the community setting.

70 general practitioners were surveyed on using liquid biopsy to diagnose lung cancer.

Only 12 % & 9 % of those surveyed were aware of molecular testing and liquid biopsy.

39 % of those surveyed were familiar with molecularly targeted treatments.

72 % of those surveyed would use liquid biopsy to test circulating tumor DNA.

Education and funding are needed to apply liquid biopsy in the community setting.