For hospital leaders and oncologists alike, precision medicine offers the potential to dramatically advance cancer care.
Defined by the National Institutes of Health as a “form of medicine that uses information about a person’s genes, proteins and environment to prevent, diagnose and treat disease,” precision medicine includes treatments such as immunotherapies that stimulate the patient’s immune system to help the body fight disease; molecular therapies that target specific proteins involved in the growth of disease; and gene therapies that introduce or alter cellular genetic material to compensate for abnormal or mutated genes.
Treatment for more than 7,000 inheritable genetic disorders, as well as diseases such as cancer with genetic underpinnings, may be significantly improved in the coming years as result of precision medicine research. Over the past year there have been important advances, such as the FDA approval of two CAR-T therapies for blood cancers and the approval of a PD-1 inhibitor for MSI high tumors regardless of origin. Targeted medicines for acute myeloid leukemia, bladder, ovarian, breast and lung cancers are also now available, and in some cases have proven better than older traditional chemotherapies.
To better understand how these treatments may be accepted in the marketplace, Cardinal Health Specialty Solutions surveyed more than 160 U.S. oncologists to understand their perceptions of precision medicine and possible barriers to adoption. We also looked at the availability of genomic testing at local institutions and how testing may impact diagnosis and treatment. The responses, compiled in our third Oncology Insights report, provide valuable insights into how precision medicine is beginning to reshape oncology care.
Game changer or too soon to tell?
Only about 10 percent of malignancies are currently treated using targeted or gene therapies. But the survey suggested that number is likely to rise exponentially as 36 percent of participants said they expect a large portion of oncology patients will be treated with precision medicines in the next 2-3 years, and four in ten view precision medicine as a potential game changer. But there remains some caution. The majority of respondents (57 percent) said it’s too soon to predict the long-term impact of precision medicine, and many (59 percent) say they see high costs as a significant barrier to adoption.
These responses may reflect a lack of direct experience with precision medicines among oncologists. Hospital systems can help to address this by participating in clinical trials that investigate efficacy of precision medicines, enabling their physicians to gain firsthand experience managing these therapies and their side effects, while also giving eligible patients access to innovative care. There may also be opportunities to participate in post-marketing observational studies of how precision medicines are being used in real-world settings.
Key issues for hospitals
The findings on genomic testing have particularly important implications for hospital leaders. Genomic tests play a central role in identifying patients with genetic abnormalities who may have the greatest likelihood of responding to targeted medicines.
Nearly all participating oncologists – 97 percent – said genomic testing is important for diagnosing and treating cancer patients. About two-thirds of participants said they routinely use genomic testing to identify the best treatment options, with another 23 percent reporting they are likely to begin using it in the year ahead.
Yet availability of genomic testing and turnaround times for results vary greatly. For instance, 58 percent of participants reported that testing is not available at their local institution and 26 percent said they wait 15 days or longer for results. Even if tests are sent out for processing, reducing turnaround times is critical. Most health systems batch the tests once or twice a week, which can lead to significant delays in the start of treatment. Ideally, more hospitals can adopt in-house capabilities to perform these tests to ensure timely results.
Our research also found that difficulty understanding test results is a barrier to use. Nearly six in 10 participating oncologists said results are not easy to interpret when making clinical decisions. While there are thousands of genomic tests available today, the decision on when to order them is not always clear. Investing in additional training for both the physicians ordering the tests and the pathologists conducting the tests may help to reduce the confusion and optimize the testing process.
Reimbursement for genomic tests is another important issue. The report found that prior authorizations are required for most genomic tests, although policies vary widely among insurance companies. And even when the prior authorization process is completed, some payers still deny reimbursement. This clearly indicates that engaging payers in discussions about the value of genomic testing is critical, and hospital systems can influence these processes with supporting clinical trial data.
Our research results indicate that the swift adoption of these precision medicine therapies is not guaranteed though science is advancing rapidly. Hospital leaders can play an important role in advancing precision medicine by improving access to genomic testing, participating in clinical trials and observational studies, and engaging payers in discussions on the value of these promising new treatment options.
To learn more about how oncologists view the advance of precision, download the full report at cardinalhealth.com/oncologyinsights.
Dr. Nabhan is Chief Medical Officer for Cardinal Health Specialty Solutions, a leading provider of solutions to help specialty pharmaceutical companies enhance product success and health care providers enable exceptional patient care. With more than 17 years of clinical practice experience, he brings broad real-world healthcare management expertise in a variety of settings, including community, hospital-based and academic centers, as well as significant experience with clinical research, quality metrics, benchmarking and managed care.