SDOH Drive Disparities in NGS Access Across Cancers

Social determinants of health (SDOH) disproportionately impact access to next-generation sequencing (NGS), which has been shown to improve survival outcomes in patients with advanced care, according to a new study published in JAMA Network Open.¹

NGS enables comprehensive genomic profiling, thus expanding patients’ options of targeted therapies that have shown to improve survival with advanced cancer. However, many patients with advanced or metastatic cancer who are eligible for biomarker-directed targeted agents don’t receive them.² This study, one of the largest to assess NGS utilization when associated with SDOH and access to genomic profiling, aimed to quantify the gap in access to care by pinpointing which patient populations are less likely to receive NGS after diagnosis.

Patient data was derived from deidentified electronic health records from the Flatiron Health Research Database. The study included patients diagnosed with metastatic breast cancer (mBC), metastatic prostate cancer (mPC), advanced non–small cell lung cancer (aNSCLC), metastatic pancreatic cancer (mPanC), and metastatic colorectal cancer (mCRC) between January 1, 2018, and December 30, 2022. The primary end point was NGS after diagnosis and death.

In the final analysis, there were 63,294 patients with advanced or metastatic cancer with a median age of 68 years, of whom 53.7% were female. Of them, 2.7% were non-Hispanic Asian, 10.0% non-Hispanic Black, 6.0% Hispanic, 61.0% non-Hispanic White, 9.3% other, and 11.0% unknown. In regard to cancer type, 19.1% had mBC, 6.9% had mPC, 42.7% had aNSCLC, 21.6% had mCRC, and 9.7% had mPanC.

NGS Testing and Disparities by Tumor Type

mBC

In the mBC cohort, the median time to NGS was 2.9 (95% CI, 2.7-3.1) months. The cumulative incidence of NGS was 26.2% (95% CI, 25.4%-27.0%) at 1 year after diagnosis. However, in 2018, the cumulative incidence was 11.8% (95% CI, 11.8%-14.3%) at 1 year, whereas in 2022 it was 39.3% (95% CI, 36.3%-42.2%) at 1 year.

Although the overall time to NGS after diagnosis decreased for patients with mBC between 2018 and 2022, patients with low socioeconomic status (SES), Hispanic patients, those covered by Medicare or other government programs, and those treated in academic practices had a significantly longer time to NGS.

mPC

In the mPC cohort, the median time to NGS was 11.0 (95% CI, 9.8-11.0) months. The cumulative incidence of NGS was 24.6% (95% CI, 23.3%-25.9%) at 1 year after mPC diagnosis. Similar to the mBC cohort, the cumulative incidence of NGS at 1 year also increased between 2018 (10.3% [95% CI, 8.6%-12.1%]) and 2022 (37.1% [95% CI, 30.5%-43.6%]).

Hispanic patients, those covered by Medicaid, and those treated in academic practices also had a significantly longer time to NGS.

aNSCLC

In the aNSCLC cohort, the median time to NGS was 0.96 (95% CI, 0.93-0.96) months. The cumulative incidence of NGS was 58.3% (95% CI, 57.7%-58.9%) at 1 year after an aNSCLC diagnosis. Similar to the other advanced and metastatic cancers, cumulative incidence of NGS at 1 year increased between 2018 (41.9% [95% CI, 40.7%-43.1%]) and 2022 (74.5% [95% CI, 72.8%-76.0%]).

When compared with patients with the highest SES, those with aNSCLC and low SES experienced a longer time to NGS. Non-Hispanic Black patients, those covered by Medicaid or other government programs, and those treated in academic practices had a significantly longer time to NG. Additionally, when compared with female patients, male patients with aNSCLC also had a significantly longer time to NGS after diagnosis.

mCRC

In the mCRC cohort, the median time to NGS was 1.5 (95% CI, 1.5-1.6) months. The cumulative incidence of NGS was 56.3% (95% CI, 55.5%-57.2%) at 1 year. In 2018, the cumulative incidence at 1 year was 41.2% (95% CI, 39.5%-43.0%) compared with 78.1% (95% CI, 75.7%-80.4%) in 2022.

Similar to patients with other metastatic and advanced cancers, those with mCRC who had low SES had significantly longer times to NGS vs those with the highest SES. Additionally, non-Hispanic Black patients, Hispanic patients, those covered by Medicare or other government programs, and those treated in academic practices also had a significantly longer time to NGS.

mPanC

In the mPanC cohort, median time to NGS was 1.3 (95% CI, 1.2-1.3) months. The cumulative incidence of NGS was 50.3% (95% CI, 49.0%-51.6%) at 1 year. Between 2018 and 2022, the cumulative incidence of NGS at 1 year increased from 29.8% (95% CI, 27.3%-32.3%) to 62.2% (95% CI, 58.6%-65.6%).

Non-Hispanic Black patients with mPanC, those covered by Medicare or other government programs, and those treated in academic practices had a significantly longer time to NGS.

This study was limited by the missing data, specifically certain patient exposures and misclassification bias. Availability and line of therapy of targeted treatments across cancer types during the study period may have also influenced the timing of NGS.

“These results have the potential to inform health care policies and educational efforts aimed at bridging these gaps and addressing the underutilization of NGS in the most common advanced cancers in the US,” the study authors concluded.

References

1. Chehade S, Ozay ZI, Jo Y, et al. Trends and disparities in the use of next-generation sequencing in patients with cancer in the United States. JAMA Netw Open. 2026;9(4):e265585. doi:10.1001/jamanetworkopen.2026.5585

2. Nesline MK, Amoah K, DePietro P, et al. Screening for social determinants of health among patients with advanced and metastatic cancer undergoing comprehensive genomic profiling in underserved communities. J Clin Oncol. 2024;42(suppl 16):e13545. doi:10.1200/JCO.2024.42.16_suppl.e13545