Integrating precision cancer medicine into healthcare—policy, practice, and research challenges

Abstract

Precision medicine (PM) can be defined as a predictive, preventive, personalized, and participatory healthcare service delivery model. Recent developments in molecular biology and information technology make PM a reality today through the use of massive amounts of genetic, ‘omics’, clinical, environmental, and lifestyle data. With cancer being one of the most prominent public health threats in developed countries, both the research community and governments have been investing significant time, money, and efforts in precision cancer medicine (PCM). Although PCM research is extremely promising, a number of hurdles still remain on the road to an optimal integration of standardized and evidence-based use of PCM in healthcare systems. Indeed, PCM raises a number of technical, organizational, ethical, legal, social, and economic challenges that have to be taken into account in the development of an appropriate health policy framework. Here, we highlight some of the more salient issues regarding the standards needed for integration of PCM into healthcare systems, and we identify fields where more research is needed before policy can be implemented. Key challenges include, but are not limited to, the creation of new standards for the collection, analysis, and sharing of samples and data from cancer patients, and the creation of new clinical trial designs with renewed endpoints. We believe that these issues need to be addressed as a matter of priority by public health policymakers in the coming years for a better integration of PCM into healthcare.

Analyzing the clinical actionability of germline pharmacogenomic findings in oncology

“…34 Perhaps this should not be surprising, given that oncologists are well versed in making decisions about oncologic therapies based on tumor genomics. 35,36 Indeed, oncology practices already have had to solve many of the barriers of genomic clinical implementation. These include finding trusted laboratories to perform the testing, managing cost hurdles and insurance coverage questions, pursuing results in a timely fashion, storing results within the electronic health record, and communicating results with patients.…”

Precision health contributions to public health: An integrative review

“…Breast cancer risk can now be predicted using models that screen the BRCA1/ BRCA2 genes, which are responsible for breast cancer, as well as age, ethnicity, lifestyle, family history and environmental factors. In addition, the specific genetic mutations of cancer cells (like olaparib inhibiting BRCA1/ BRCA2/ BRCA3 in ovarian cancer) can be investigated (Bertier et al, 2016). The process becomes more feasible with the rise of genetic banks, Amba et al 229 which can be used as comparison points to find driver mutations that contribute to cancer, rather than passenger mutations (which do not contribute to cancer) (Bertier et al, 2016).…”

“…In addition, the specific genetic mutations of cancer cells (like olaparib inhibiting BRCA1/ BRCA2/ BRCA3 in ovarian cancer) can be investigated (Bertier et al, 2016). The process becomes more feasible with the rise of genetic banks, Amba et al 229 which can be used as comparison points to find driver mutations that contribute to cancer, rather than passenger mutations (which do not contribute to cancer) (Bertier et al, 2016). The microenvironment can also have an effect on the growth of harmful cancerous mutations.…”

“…For example, the discharged blood of the lungs was analyzed and a biomarker that had the ability to detect lung cancer 30 months prior to original diagnosis (Hanash and Taguchi, 2011) was found. Liquid biopsies can also be conducted to find circulating tumor DNA even before genetic screening, by viewing the blood instead (Bertier et al, 2016). By analyzing a wide variety of specimens and unique sources for biomarkers, cancer can be more predictable.…”

“…Through new technologies such as protein profiling and the use of DNA chip, the effect of genes in the disease of an individual can be analyzed. More than 1100 genetic biomarkers have been discovered through these methods to work towards targeted cancer therapy (Bertier et al, 2016). Breast cancer risk can now be predicted using models that screen the BRCA1/ BRCA2 genes, which are responsible for breast cancer, as well as age, ethnicity, lifestyle, family history and environmental factors.…”