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Eliminating Precision Medicine Disparities

Identification of actionable biomarkers continues to drive application of precision medicine in oncology. For patients with lung cancer, molecularly targeted therapies based on expression of specific biomarkers may be potential treatment options. Only through biomarker testing can clinicians discover whether lung cancers have targetable biomarkers.

Despite increasing evidence supporting the role of biomarkers in treatment decision-making for patients with lung cancer, recent studies^1-3 report that more than 70 percent of patients treated in the community do not receive biomarker testing as recommended by National Comprehensive Cancer Network (NCCN) clinical practice guidelines, and more than 50 percent of patients do not receive appropriate precision medicine therapies based on the test results.² Among underserved patient populations, the gap is even wider.^4,5 Analysis of CMS claims data has revealed that Medicaid patients are 40 percent less likely to get tested than patients with private health insurance and Medicaid patients are 30 percent less likely to receive targeted therapies after testing, compared to patients with private health insurance.⁴

The ACCC Eliminating Precision Medicine Disparities project is focused on understanding specific barriers and challenges to equal access to precision medicine among underserved patient communities. Through this project, ACCC seeks to:

Evaluate patient and provider perceptions of equity in access to biomarker testing and gaps in access to appropriate precision medicine therapies based on identification of actionable biomarkers.
Gather feedback from patients and healthcare providers regarding specific barriers and challenges in obtaining biomarker testing and access to precision therapies.
Develop interventions for both patients and providers to promote biomarkers testing for patients with lung cancer in underserved communities.

The project is guided by an expert multidisciplinary Advisory Committee. ACCC is pleased to partner with LUNGevity for the patient-facing components of this education intervention.

For more information on this project, please contact the ACCC Provider Education department.

Video Podcast

[VIDEO PODCAST] Ep 09: Precision Medicine Disparities
Nov 11, 2021
Hear from two authors of an ACCC/LUNGevity Foundation study that identified key areas of clinician need related to biomarker testing in NSCLC.

Christopher S. Lathan, MD, MS, MPH
Chief Clinical Access and Equity Officer
Dana-Farber Cancer Institute

Nikki Martin
Director of Precision Medicine Initiatives
LUNGevity Foundation

From Oncology Issues

Biomarker Testing in Patients With Non-Small Cell Lung Cancer
Leigh M. Boehmer, PHARMD, BCOP; Upal Basu Roy, PHD, MPH; Janelle Schrag, MPH; Nikki Martin, MA; Alexandra Howson, PHD; Latha Shivakumar, PHD, CHCP; Brad Coleman, PMP; and Greg Salinas, PHD

While recent advances in precision medicine have substantially changed the management of lung cancer, care must be taken to ensure that these advances do not worsen health disparities. This study included a case component that divided overall respondents into two cohorts to observe how patient characteristics, such as age, socio-economic status, race/ethnicity, and health literacy, affected the likelihood of ordering biomarker testing.

Patient Perceptions of Biomarker Testing
Nikki Martin, MA; Lisa Dropkin; Lydia Redway; Mariel Molina; Janelle Schrag, MPH; Latha Shivakumar, PhD, CHCP; Leigh M. Boehmer, PharmD, BCOP; and Upal Basu Roy, PhD, MPH

As precision medicine becomes more common in the management of lung cancer, little is understood about the patient experience with biomarker testing, particularly of underserved patients. This study used survey and focus group methodology to determine patient perspectives on the educational needs within this community.

Appendix A: Patient Survey
Appendix B: Focus Group Guide

Interactive eCourse

Health Literacy Best Practices for Lung Cancer Biomarkers

Now available is a 30-minute eCourse for members of the multidisciplinary cancer care team on how to use consistent, evidence-based health literacy best practices as it relates to lung cancer biomarker testing. Complete “Health Literacy Best Practices for Lung Cancer Biomarkers” to gain a lexicon of health terminology that resonates with patients and their caregivers and access downloadable resources about health literacy and biomarkers.

Access eCourse

Featured Resource

Paying for Biomarker Testing

Paying-for-Biomarker-Testing-275x356 A biomarker is a substance that doctors can measure in your tissues, blood, or other body fluids, like fluid around your lungs. Cells with certain biomarkers have errors (mutations) in their genes or changes in their protein levels that cause cells to divide in an uncontrolled way. This can cause lung cancer. It’s important to note that biomarker testing looks at your cancer’s cells and is not the same thing as genetic testing which looks for inherited changes to cells.

If biomarker testing shows that you are positive for a certain biomarker (positive means you have it), your doctor can choose treatments that work to attack the specific biomarker you have.
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Presentations & Abstracts

[Abstract 123] Identifying barriers to equitable biomarker testing in underserved patients with NSCLC: A mixed-methods study to inform quality improvement opportunities Sep 24, 2021
Presented at the 2021 ASCO Quality Care Symposium, September 24 - 25, 2021.
[Abstract] A United States study focused on patients' understanding of, attitudes towards, and barriers to the use of biomarker testing for NSCLC Sep 10, 2021
Presented at the IASLC 2021 World Conference on Lung Cancer, September 8-14, 2021

News & Media

Poor Oncologist-Patient Communication Adding to NSCLC Biomarker Testing Disparities, Survey Finds
Precision Oncology News, Feb 28, 2002

Leigh M. Boehmer, PharmD, on Real-World Inequities in NSCLC Biomarker Testing
MedPage Today, Feb 4, 2022

Overcoming Barriers to Genomic Testing in Community Care Settings
Contemporary OB/GYN, Nov 3, 2021

Overcoming Barriers to Genomic Testing in Community Care Settings
Targeted Oncology, Nov 2, 2021

Survey Examines Oncology Clinician Perceptions of Biomarker Testing for Underserved Patients With Lung Cancer
The ASCO Post, Sep 15, 2021

Lung Cancer Biomarker Testing Survey Reveals Access Gaps, Attitudes in Community, Academic Practices
Precision Oncology News, Sep 15, 2021

Minority of Clinicians Understand, Use Biomarker Guidelines in NSCLC Treatment or Patient Discussions
WCLC Meeting News, Sep 14, 2021

Association of Community Cancer Centers Releases Report at IASLC 2021
ACCC, Sep 13, 2021

Biomarker testing decisions for lung cancer vary between academic, community oncologists
Healio, Sep 11, 2021

References

Gutierrez ME, Choi K, Lanman RB, et al. Genomic profiling of advanced non-small cell lung cancer in community settings: gaps and opportunities. Clin Lung Cancer. 2017;18(6):651-659.
Mason C, Ellis PG, Lokay K, et al. Patterns of biomarker testing rates and appropriate use of targeted therapy in the first-line, metastatic non-small cell lung cancer treatment Setting. J Clin Pathw. 2018;(1):49–54.
Audibert CM, Shea MB, Glass DJ, et al. Trends in the molecular diagnosis of lung cancer: results from an online market research survey. Washington, DC: Friends of Cancer Research; 2018.
Palazzo LL, Sheehan DF, Tramontano AC, et al. Disparities and trends in genetic testing and erlotinib treatment among metastatic non-small cell lung cancer patients. Cancer Epidemiol Biomark Prev. 2019;28(5):926-934.
Wong W, Wu N, et al. ALK testing trends and patterns among community practices in the United States. JCO Precis Oncol. 2018;2:1-11.

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