On February 25, 2019, the Journal of Oncology Practice published an article on precision medicine as part of the State of Cancer Care in America series. “Implementing Precision Medicine in Community-Based Oncology Programs: Three Models,” which draws from last year’s inaugural State of Cancer Care in America event, Precision Medicine: Expanding Opportunities, highlights existing challenges and offers three distinct examples of oncology practices successfully implementing precision medicine programs.
The article finds that precision medicine is rapidly becoming the standard of care for patients with advanced cancer, and that clinical decision support and administrative support for prior authorization and clinical trail matching are key to successfully implementing precision medicine. The authors write, “Moving forward, it will also be critical that these programs collect and report outcomes of their patients who are treated off labels, so that the community learns from every patient how best to use precision medicine.”
Challenges to Precision Medicine
The article provides an overview of some of the existing clinical, administrative, and financial challenges that make it difficult for oncology practices to implement precision medicine. For example:
- Because multiple molecular diagnostic tests are available, clinicians may not be able to readily identify the right test for each patient.
- Genomic reports often include large amounts of information, which makes it difficult for clinicians to use the results to match patients to the right treatments or to a clinical trial.
- The rapid advancement of precision medicine makes it hard for clinicians to keep pace with new treatments and indications.
- Not all genomic tests are covered by insurance, and even payers that do cover tests often require prior authorization, which delays patient access to care.
- A lack of interoperability between genomic data and laboratory results in Electronic Health Records hinders access to data and clinicians’ ability to match patients with clinical trials and new treatments
Precision Medicine in Clinical Practice
The article looks at three examples of large, multisite practices or networks to illustrate how precision medicine has been successfully implemented in non-academic settings:
Intermountain Healthcare: Intermountain offers in-house genomic analysis, a molecular tumor board (MTB) to interpret genomic test results, clinical pathways, and nurse navigators for clinical trial matching, and drug procurement services. The program, which was initially piloted in 2013, has resulted in better clinical outcomes for patients at costs similar to or lower than standard treatment.
Levine Cancer Institute, Atrium Health: Precision medicine at Levine Cancer Institute involves a standardized approach to diagnosis and treatment based on genomic testing, an in-house MTB, clinical pathways, and a clinical trial matching system.
National Cancer Care Alliance: Precision medicine at practices belonging to the National Cancer Care Alliance is organized around clinical pathways, which are developed by committees of academic and community oncologists and updated quarterly. Alliance practices do not have a standard approach to genomic testing or precision medicine, however, they are piloting a clinical trials infrastructure to streamline access to trials by centralizing contracting, data management, and regulatory compliance aspects.