March 2013 Edition Vol.7, Issue 3

Molecular Testing: Preparing for the New Normal in Community Oncology

Molecular Testing: Preparing for the New Normal in Community Oncology

By Neil Canavan

We’ve been hearing about it for years—this mantra, this Holy Grail of enlightened, emboldened healthcare called Personalized Medicine. But moving beyond the one-size-fits-all clinical approach is going to require very specific and very personal information from the patient; and that data will be acquired, in large measure, through sophisticated molecular testing (MT).

For practices to transition from current diagnostic habits in oncology to a more molecular mindset certain requirements will need to be fulfilled, such as education, organization, and an upfront commitment of financial resources.

To address these requirements, the Association of Community Cancer Centers (ACCC) commissioned a study of current perceptions, opinions, and best practices of its members in regards to MT. Results of that study which consisted of two online surveys of ACCC members, as well as follow-up interviews, were presented in San Antonio at the ACCC annual meeting and are now available online to members.

The multidisciplinary survey targeted oncologists, administrators, nurses, and pharmacists. A total of 52 cancer programs submitted responses, representing cancer programs in more than 25 states. The pathologist survey (n=17) included some additional discipline-specific questions. Both surveys examined current practices, policies, and procedures; testing processes; reimbursement; and administrative issues.

As to who is leading the charge for adoption, the survey showed that according to 58.8% of pathologists who responded, oncologists are the ones who provide primary guidance on biomarker testing. However, 38% of multidisciplinary respondents reported that pathologists are the ones taking the lead.

Roughly one-third of respondents said they have plans to bring new molecular tests in house within 6 months; 35.3% of pathologists reported they planned to bring new molecular tests in house within the same time frame. Susan Myers, MA, MPH, President, Health Equity Associates, Havre de Grace, Maryland, noted at the AAAC meeting that adoption of new tests is a good starting point, “but it does suggest there is room for growth in the area of policy.”

When asked: Does your program use guidelines on the use of MT, and if so, which one(s)? Seventy-six percent of respondents indicated that they use guidelines, primarily the NCCN, College of American Pathologists, and ASCO, in descending order.

Digging a bit deeper, the survey asked whether a given facility had developed internal administrative guidelines regarding MT—only 41% indicated that they had. Myers observed that this represents a need for community centers to consider the utility of having administrative guidelines.    

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Article Comments

Judi Space

quotes Completely agree with the "Wild West" analogy, Neil. Oncologists and pathologists in many community hospitals often on different planets, and one of the biggest issues is about who will pay for the tests. Key players in this scenario are the payors who pose yet another barrier, which seems so counterintuitive. When pts test negative, it gives them an opportunity to refuse payment for some of these expensive targeted drugs. quotes

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