Advancing Precision Medicine in Community Oncology Practice

Despite expanded use of precision medicine, there remain a myriad of barriers hindering its implementation in day-to-day practice.

Community oncology practices and the patients they care for can greatly benefit from the use of precision medicine (PM). In addition, as the cost of next-generation sequencing (NGS) has dropped, its use in clinical practice and research has expanded rapidly.

However, there remain a myriad of barriers that have hindered the implementation of PM and NGS in day-to-day practice, according to an article published in Targeted Oncology®.

Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care Associates and president of the Community Oncology Alliance, coauthored the paper.

“Factors like integration into practice guidelines, lack of consensus and standardization between different stakeholders regarding minimum number of mutational analysis, germline studies, platforms for testing, and payer coverage threaten realization of PM,” wrote Patel and colleagues. Patel is also the associate editor of The American Journal of Managed Care®’s Evidence-Based Oncology™.

However, the biggest challenge is the lack of diversity, Patel and his colleagues wrote. Not only do minority communities currently face discrimination and receive poor treatment, but there is a long history of exploitation, abuse, and marginalization. Studies have shown that Black patients are undertreated for pain compared with White patients. Past abuses, such as the Tuskegee Syphilis Study—in which Black men were denied effective treatment for syphilis so researchers could document the natural course of the disease—have also contributed to mistrust among minority populations.

Despite this, underrepresentation of minority populations in PM and clinical trials is “more likely due to the research design of the study or limited accessibility.” The authors noted that genome-wide association studies in 2009 with 1.7 million samples showed that 96% of participants were of European ancestry. Not much changed years later. When 35 million samples were collected 7 years later, the analysis revealed 81% of participants were of European ancestry.

“Clearly, racial and ethnic diversity of the samples still had a long way to go,” they wrote.

As part of their article, Patel and colleagues provided suggestions for the successful implementation of PM and different ways to approach testing to ensure the success of PM. Some of these suggestions include improving identification of patients of clinical trials; equitable access to genomic and genetic, as well as treatment, data; making widespread testing accessible locally; and improving access to testing for minorities.

“Because of limitations in access to overall testing, limited uptake of testing…and skewed data disproportionately representative of Caucasians, the success of PM is not likely to be accomplished unless we explore different ways to approach testing,” they concluded.

Read the full article at Targeted Oncology®.