Last year, the FDA approved 27 precision oncology drugs, a 35 percent increase in the number of approvals from 2019. Although more and more biomarker-informed therapies are being developed and launched, not all patients have access to them due to numerous barriers, including difficulties accessing genetic testing, limited physician expertise, challenges setting up clinical trials in the community, and reimbursement pressures. Patients’ social determinants of health also continue to influence whether they receive, or are even offered, biomarker testing and downstream treatment options.
To better understand these issues, Canexia Health recently sponsored a virtual roundtable, hosted by GenomeWeb, focused on disparities in access to precision oncology. Kellie Jack of Weill Cornell Medicine, Raymond Osarogiagbon of Baptist Cancer Center, Rachit Kumar of Maine General Medical Center, and Greg Tranah of Sutter Health discussed their perspectives working within small and large health systems across the US.
After highlighting respective challenges within their own systems and contexts, they shared insights for advancing equitable access:
- Hospitals and health systems are in a position to deploy economies of scale to provide more equitable access to precision medicine, rather than engaging in retail-level negotiation for each patient. “The solution to health equity is least efficient at the individual patient level. It is most efficient at the policy level, and right underneath that, at the organizational level. That really is where we ought to be focusing our efforts,” Osarogiagbon said.
- Tranah added that solving this issue at the healthcare system level does not necessarily mean establishing a relationship with a single commercial entity, but may involve partnering with a company to bring certain tests in-house to provide them more quickly and at a smaller cost.
- Regarding clinical trial enrollment, Kumar noted that his approach to bringing clinical trials to Maine General Medical Center is to focus on those that address the cancers with the highest incidence in Maine, i.e., lung, breast, and gastrointestinal cancers. The Maine General research team is affiliated with Maine Health, the largest healthcare provider in the state. Trials, therefore, enroll at sites throughout the state using a hub-and-spoke model, increasing access in rural areas.
- Jack highlighted that the COVID-19 pandemic gave healthcare inequities a spotlight that can be used to initiate discussions in other areas. She said she remains optimistic about progress in addressing bias and hopes that offices of community outreach and engagement take advantage of the current momentum.
- Insourcing testing and liquid biopsy were among other promising solutions. “The hope is that someday the technology will get us to a point where getting genomic testing can be done just as readily as getting a [complete blood count]. When that day arrives,” Osarogiagbon said, “a lot of these obstacles that we are talking about will go away.”