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Technology & Innovation
The Oncology field is experiencing profound change. The paradigm has shifted in how we treat patients, how we diagnose them, and the therapies we employ. For example, consider the growing number of biomarkers for cancer. We’ve gone from fewer than 6 in 2005 to more than 50 in 2019 to nearly 120 this year. Some of these markers are prognostic, some are diagnostic, some are therapy selective. The evolution of our knowledge has exploded. With the advent of artificial intelligence, or “AI”, the use of digital pathology, and the continued advancement of technology in oncology, we’ll only gain a more comprehensive approach to understanding cancer and the patient.
At the cutting edge of testing: blood-based diagnostics
One important topic in oncology is blood-based tests. Liquid biopsies may still be in their relative childhood, but thanks in part to the number of biomarkers to look for, they are quickly becoming a standard in oncology testing. Tissue is unlikely to ever be supplanted, but blood-based testing is shaping up to be a strong partner of therapy selection, and potentially prognostics and diagnostics as well.
Colorectal cancer is a great example of a disease state where the screening test is somewhat invasive (that is, a colonoscopy) and people are reluctant to undergo the procedure. If we could identify patients at elevated risk of this disease through a blood assay based on venipuncture, it would be much more palatable to patients.
Our ultimate goal is to achieve true personalized medicine, where our treatment is tailored specifically for each patient. At the forefront of this goal is therapy response and disease monitoring. Novel approaches to minimal residual disease, which seek to identify patients who may benefit from additional therapy and monitor those who may have recurrence, are truly delivering on that promise of personalization.
The mainstreaming of bioinformatics
Bioinformatics has evolved rapidly since we started digitizing health records. Once they’re digitized, these records are mineable, which has driven our understanding of cancer and the evolution of the field. As we look to identify new biomarkers, therapies, and targets, this information becomes a discoverable asset that furthers progress and creates a snowball effect.
With digital pathology, we’re able to marry the phenotypic expression of a disease with the genotypic components of that disease through molecular testing. The power of this approach coupled with patient outcomes will accelerate and revolutionize our understanding of cancer care.
Build versus buy
There remains the obvious question of whether it is better to decentralize molecular testing into the oncology clinic/health system or outsource and work with a reference partner. A major consideration for this should be the rate of change in molecular testing and oncology, which will cause many pieces of the highly specialized equipment purchased today to likely be outdated in 2 to 3 years. This translates to a failure to fully materialize the depreciation value of that equipment before it’s already out of date.
Partnering may be an attractive approach to meet the dual goals of sophisticated cancer testing and managing cost when you consider the rate of technology change, the cost of reagents, absorbing the cost of payer denials, the economies of scale required for economic viability, and the payroll impact of skilled staffing to perform these kinds of tests. In fact, the skilled labor force required for this testing may be difficult to find in some markets, either from competition or scarcity of qualified individuals.
The role of an oncology testing partner
In addition to concerns around cost, complexity, and even patient concerns that their genetic results might be sold to a third party, capability and cultural fit issues define a rewarding relationship between a health system and a lab partner.
I would advise health systems to look at several different areas:
- Comprehensive menu. Even when dealing with a large reference lab, clinicians may doubt whether a partner they’ve used in the past offers coverage in areas like bioinformatics. It always makes sense to check the portfolio of an oncology test partner to ensure the tests you may need are within their capabilities, and that they continue to evaluate new technologies and assays that might offer better results.
- Continuum of care efficiency. Many scenarios exist where a patient’s cancer might be advanced by the time they go to their PCP, get a referral, and reach the oncologist’s office. That’s why clinicians are looking for efficiency. This means not just ease of ordering tests, but ease and speed of receiving results, and intelligent integration of those results into their EMR system.
- Interpretation and support. Some next-generation sequencing, or NGS, test results run to 20 pages, so the implications and interpretation may not be apparent. A good lab partner should have on-site experts like oncologists and pathologists who can help with consultation and interpretation. Additionally, reports should be clear, concise, and comprehensive. These characteristics provide downstream benefits when therapy decisions need to be made.
- Access. Access is often as much of a challenge as technology. Recent research among metastatic non–small cell lung cancer (NSCLC) patients showed that less than half of patients received comprehensive biomarker testing.1 This has implications for early detection, diagnosis, treatment, prognosis, response, and the patient’s personalized medicine plan. Your test partner should offer programs that increase testing access for high-risk and underserved populations, as well as screening outreach campaigns. Financial assistance programs should be in place for situations where out-of-pocket expenses may be prohibitive for some patients.
- Turnaround time. It’s no secret that one of the key areas of focus is turnaround time, delivering results and information to the clinician in as timely a manner as possible—and contribute meaningfully to the diagnostic process as well as treatment. Many oncologists don’t have the luxury of time to wait for 10, 15, or even 28 days for molecular biomarker results to render a therapeutic decision. By giving them the information they need faster, testing partners can help oncologists make the best treatment decisions for their patients.
- A patient care mentality. A professional mentor of mine likes to say that it really does take a village, especially in oncology. If your lab partner can bring a capability that will improve patient care in any way, it should be their responsibility to do so. This mentality also extends to the test partner’s attitude that behind every test is someone’s mother, brother, or father, and that these patients deserve to have their samples treated with the utmost respect and an eye on the highest possible quality.
Ultimately, the pathologists in your health system should have complete confidence in your lab partners so they can actively participate in the continuum of care and meaningfully contribute to the treatment as well as the diagnostic process. The health of your patients and your health system can only benefit.