Next-generation sequencing (NGS) may be economically beneficial for select patients with treated in the community oncology setting, but it should be carefully applied due to potential associated financial burdens, according to research presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
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Advances in cancer care—such as precision medicine, immunotherapy, and targeted treatment—have benefitted select patients with cancer. NGS is now used in the community setting to determine patient appropriateness for advanced therapies; however, little research exists regarding the financial implications of such testing.
Natraj Reddy Ammakkanavar, MD, medical oncologist at Community Cancer Center (Indianapolis, IN), and colleagues performed a retrospective analysis of 209 patients (median age, 64 years) treated at a large, nonacademic outpatient facility who received NGS. Cancer subtypes included in the study were lung cancer (n = 63), colorectal cancer (n = 31), ovarian or endometrial cancer (n = 23), breast cancer (n = 15), pancreatic cancer (n = 9), and other cancers (n = 68).
The researchers categorized patients based on changes in management (CIM) following NGS. The four study categories were CIM for current; potential CIM with subsequent therapy; no CIM due to poor performance status; and no CIM due to lack of appropriate therapy.
The majority of patients (66%; n = 137) were categorized as no CIM due to lack of appropriate therapy. Fifteen further patients received no CIM due to poor performance status. None of the 31 patients with colorectal cancer received a change in management after accounting for RAS mutation status, which is determined through standard testing. Among the 54 patients who had a CIM following testing, six had available alternative screening options.
NGS tests created a financial responsibility of approximately $1.21 million. After exhausting insurance reimbursement and support systems, a total of 35 patients (2015, n = 18; 2016, n = 17) were billed for testing.
“Benefits with later therapy are difficult to predict,” the researchers wrote. “NGS should be used more judiciously due to the financial implications.”—Cameron Kelsall
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