Lagging adoption of cancer test<\/strong><\/p>\nUsing information from a large Blue Cross Blue Shield health insurance claims database, Dinan and her co-authors applied a novel algorithm to examine BGP use in over 50,000 U.S. patients diagnosed with the 10 most common metastatic cancers between 2020 and 2022. The authors documented BGP use within six months of advanced or metastatic cancer diagnosis.<\/p>\n
Throughout the study period, about 1 in 5 patients received BGP. Its use grew more common as the years progressed, rising from 15.1% of patients early in 2020 to 24.3% by mid-2022. <\/p>\n
Despite this growth, the researchers found that the BGP test was underused in all cancers, with well under half of the patients tested in most cancer categories. This pattern held even for patients with lung, pancreatic, melanoma, and breast cancers, for which BGP is explicitly recommended under National Comprehensive Cancer Network (NCCN) guidelines. Lung cancer saw the highest use of BGP at 49%. BGP tests were used more often for suspected kidney cancer\u2014for which BGP is not routinely recommended\u2014than breast cancer, the study revealed. <\/p>\n
\u201cIn lung cancer, we’ve gotten to the point where it should be the standard of care across the board,\u201d said Dr. Xiao Wang, the study\u2019s lead author and a clinical fellow in the medical oncology and hematology unit in the Department of Internal Medicine at Yale School of Medicine (YSM). The finding of 49% is \u201clower than we would expect,\u201d he said.<\/p>\n
Possible reasons for cancer test disparities<\/strong><\/p>\nPotential reasons for the testing disparities varied, according to the authors. Older age, frailty, female gender identity, and living anywhere but the Northeast were all associated with a lower likelihood of broad genomic profiling. <\/p>\n
\u201cMost diagnostic tools and treatments are often somewhat less likely to be used in older patients, since some older patients may have competing health issues or other reasons to pursue treatment less aggressively,\u201d Dinan said. \u201cThe association with female sex was not expected and is something we hope to look into more in the future.\u201d<\/p>\n
\n\nThe adoption of BGP has been growing, but many patients are still not necessarily undergoing testing.<\/p>\n<\/blockquote>\n<\/blockquote>\n
Dr. Michaela Dinan, Yale School of Public HealthAn emerging cancer tool <\/strong><\/p>\nBy detecting gene alterations relevant to a patient\u2019s cancer, BGP may point the way to clinical trials or to tailored treatments that depend on the mutated gene rather than the cancer type. The test may also tip physicians off to a more aggressive cancer. <\/p>\n
Routine use of BGP has been recommended for over a decade for patients with lung cancer, for which there are nearly a dozen treatment therapies targeting different gene alterations. For patients with breast cancer, BGP tends to be more influential for second-line treatment decisions, the authors said.<\/p>\n
In the past, Wang said, \u201cwe might test for genomic alterations individually. But as we’ve accumulated more and more [knowledge], we’ve used these broad genomic profiling platforms to test for dozens or even hundreds of genes or alterations simultaneously.\u201d<\/p>\n
Though it\u2019s more comprehensive than single-gene tests, BGP is potentially slower and more expensive. <\/p>\n
Words of caution<\/p>\n
The study has some limitations. The authors note that it was conducted only among privately insured patients; the results might differ in other populations. <\/p>\n
Wang cautioned against concluding that patients without a documented BGP received substandard care. The authors focused on BGP testing shortly after diagnosis; some patients may have gotten the test later on. <\/p>\n
\u201cIf a patient is not going to benefit from getting the test, if it’s going to take three weeks to get the test, and single gene testing can come back within a couple of days, I definitely can understand why an oncologist might forgo this type of testing,\u201d Wang said. \u201cThat just speaks to the fact that we need to improve access for those patients and make it feasible and effective for those patients to get BGP as well.\u201d<\/p>\n
The study is the first in a forthcoming series of Yale-led studies that will examine the use of BGP in U.S. cancer care. Future studies will address its effects on treatments and outcomes and whether it is cost-effective. <\/p>\n
\u201cYou can imagine that over time, as tests get faster and cheaper and we develop more and more treatments with more and more targets, that [BGP] might be more beneficial,\u201d Wang said. \u201cIt’s a really powerful tool, and we want to understand how we can best use it for our patients.\u201d<\/p>\n
The study appears in JAMA Oncology<\/a>. Funding was provided by the National Institutes of Health. <\/p>\nIn addition to Wang and Dinan, other authors on the study were Sarah B. Goldberg, also of the YSM Department of Internal Medicine\u2019s Section of Medical Oncology; John Rothen, Jessica B. Long, and Pamela R. Soulos of YCC\u2019s COPPER Center; Sida (Stark) Huang, a YSPH student; Ronac Mamtani of the University of Pennsylvania\u2019s Perelman School of Medicine; Carolyn J. Presley of The Ohio State University; Natalia Kunst of the COPPER Center and the University of York; Shuangge Ma of YSPH; Shi-Yi Wang, an affiliate of COPPER and YSPH; and Cary Gross of COPPER, YSPH, and YSM\u2019s Department of Internal Medicine.<\/p>\n
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