It’s no secret that precision medicine has revolutionized cancer care by offering more personalized treatment options based on the genomic profile of an individual’s cancer. And though single gene testing used to be enough to act on these insights, the expansion of targeted therapies on the market today has highlighted the importance of next-generation sequencing. While the promise of the technology is there, the practice has not yet caught up.
There are significant barriers stagnating the widespread adoption of genomic sequencing – and, as a result, restricting patient access to potentially lifesaving therapies. In this article, we will discuss how top-to-bottom collaboration can alleviate these hurdles and help increase equitable access to the most effective treatments for all cancer patients.
Obstacles and inequalities in accessing tumor biopsies and biopsy referral
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Recent studies have highlighted the roadblocks preventing the uptake of genomic sequencing in clinical practice. A 2022 analysis of over 38,000 patients with advanced non-small cell lung cancer (NSCLC) revealed alarming gaps in precision oncology implementation. This study found that:
- Nearly half (49.7%) of the patients did not have access to precision oncology due to various factors associated with obtaining biomarker test results.
- Additionally, 29.2% of patients who did obtain their results did not receive appropriate targeted treatments.
The above stumbling blocks are only further compounded by the lack of equitable access to tumor biopsies, with disparities found among patients from different socioeconomic backgrounds. Patients from underserved communities are less likely to undergo biopsy referral, often leading to missed opportunities for targeted therapy and positive outcomes. Challenges further persist in sample collection and evaluation, which can affect the accuracy of biomarker testing. For example, variability in tissue quality can lead to insufficient or inaccurate results, further complicating treatment decisions and wasting valuable time patients just don’t have.
Fortunately, tackling these inconsistencies can be accomplished with a few best practices:
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- Interventions should be implemented from the point of care to help ensure equitable access to biopsy services for all patients, regardless of financial status or geographic location.
- Alternative approaches such as liquid biopsy assays should be considered for cases where tissue biopsy is not feasible or poses significant risks.
- Hospitals and clinical sites must standardize protocols for biospecimen handling and implement pathology evaluation across their institutions. Investments in the right technology and infrastructure can also help improve the sensitivity and specificity of biomarker assays and lead to more reliable results for clinical decision-making.
A missing link: Biomarker test ordering
Another critical issue is the underutilization of biomarker testing, with many patients not having tests ordered before treatment even begins. To counteract this, healthcare providers must keep their finger on the pulse of biomarker testing to guide treatment decisions; this is only becoming more urgent as targeted therapies are increasingly approved for clinical use. Among the 198 new oncology drugs approved by the U.S. Food and Drug Administration (FDA) from 1998 to 2022, nearly 50% of them were precision therapies.
Delays in test result reporting can also prolong treatment initiation. Streamlining the testing process and integrating biomarker data into electronic health records can expedite treatment decisions, while the implementation of clinical decision support systems and multidisciplinary tumor boards can help facilitate the interpretation of test results – all roads leading to patients that receive the most appropriate therapies based on their genomic profile.
So, what’s the overall solution?
The biggest missing component to breaking down the above barriers is education. To make tangible strides in precision oncology, healthcare professionals must first be equipped with the knowledge and skills needed to interpret genomic data and then integrate it into patient care plans effectively. Similarly, patients should feel empowered to advocate for themselves, a feeling that could be achieved by understanding the role of biomarker testing in guiding their treatment options. Investing in education and training programs is the first step to helping us bridge the gap between research and practice.
Advancing precision oncology requires a concerted effort from everyone – stakeholders, healthcare providers, policymakers, researchers, and patients all have a responsibility to improve the current status quo.
Photo: Overearth, Getty Images
Kathy Davy is the President of Clinical Next-Generation Sequencing at Thermo Fisher Scientific. She completed her BS in Biology from the University of California, Irvine and MBA from The Fuqua School of Business at Duke University. Prior to joining Thermo Fisher, Kathy held roles at several other prominent organizations in the industry. Her expertise spans across pharmaceuticals and companion diagnostics, molecular diagnostics, cancer genomics, and next-generation sequencing. She is passionate about driving forward innovation in precision oncology to bridge the gap between research and practice.
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