Trends in Use of Next-Generation Sequencing in Patients With Solid Tumors by Race and Ethnicity After Implementation of the Medicare National Coverage Determination

Sheinson, Daniel; Wong, William; Meyer, Craig S.; Stergiopoulos, Stella; Lofgren, Katherine T; Flores, Carlos; Adams, Devon V.; Fleury, Mark E.

doi:10.1001/jamanetworkopen.2021.38219

Cited by 22 publications

(24 citation statements)

References 25 publications

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“…The present study also had only a small percentage (13.4%) of patients who had solely Medicaid coverage. While the Centers for Medicare & Medicaid issued a national coverage determination for next-generation sequencing in 2018 [ 57 ], underutilization of TGP persists among Medicaid beneficiaries whose coverage remains limited and is determined at the local/state level [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

Hoadley

Bass

Chertock

et al. 2022

IJERPH

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Tumor genomic profiling (TGP) is used in oncology practice to optimize cancer treatment and improve survival rates. However, TGP is underutilized among Black and African American (AA) patients, creating potential disparities in cancer treatment outcomes. Cost, accuracy, and privacy are barriers to genetic testing, but medical mistrust (MM) may also influence how Black and AA cancer patients perceive TGP. From December 2019 to February 2020, 112 Black and AA adults from two outpatient oncology sites in Philadelphia, PA without a known history of having TGP testing conducted completed a cross-sectional survey. Items queried included sociodemographic characteristics, clinical factors, patient–oncologist relationship quality, medical mistrust, and concerns about TGP. A k-means cluster analysis revealed two distinct psychographic clusters: high (MM-H) versus low (MM-L) medical mistrust. Clusters were not associated with any sociodemographic or clinical factors, except for age (MM-H patients older than MM-L patients, p = 0.006). Eleven TGP concerns were assessed; MM-H patients expressed greater concerns than MM-L patients, including distrust of the government, insurance carriers, and pharmaceutical companies. TGP concerns varied significantly based on level of medical mistrust, irrespective of sociodemographic characteristics. Targeted communications addressing TGP concerns may mitigate disparities in TGP uptake among those with medical mistrust.

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Section: Discussionmentioning

confidence: 99%

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

Hoadley

Bass

Chertock

et al. 2022

IJERPH

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“…Although the CMS national coverage determination increased NGS testing for Medicare patients and subsequently commercially insured patients, 20,39 those covered by Medicaid and patient assistance programs have slower growth rates of NGS testing. 38 There is substantial variability in NGS coverage because Medicaid coverage is determined at the state level. Because of differences in the racial and ethnic compositions of the insured population (Black individuals account for 20% of Medicaid enrollees and approximately 10% of Medicare or commercial enrollees), the variability in coverage contributes to the increasing racial and ethnic disparity gaps among patients with cancer.…”

Section: Implications and Future Directionsmentioning

confidence: 99%

“…Because of differences in the racial and ethnic compositions of the insured population (Black individuals account for 20% of Medicaid enrollees and approximately 10% of Medicare or commercial enrollees), the variability in coverage contributes to the increasing racial and ethnic disparity gaps among patients with cancer. 38 Finally, even for health plans with current coverage of CBT, patients may incur out-of-pocket costs that are dependent on their insurance benefits, which can be a barrier to testing if the cost-sharing amount is not affordable or may result in sticker shock or surprise bills and a subsequent financial burden if patients are not aware of the cost-sharing until after they receive their bill. Cancer care is associated with substantial out-ofpocket medical costs, which together with lost productivity and changes in employment, income, and insurance can result in financial hardships that can adversely affect patients' health outcomes.…”

Section: Implications and Future Directionsmentioning

confidence: 99%

State legislative trends related to biomarker testing

Sadigh

Goeckner

Kazerooni

et al. 2022

Cancer

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Comprehensive biomarker testing has become the standard of care for informing the choice of the most appropriate targeted therapy for many patients with advanced cancer. Despite evidence demonstrating the need for comprehensive biomarker testing to enable the selection of appropriate targeted therapies and immunotherapy, the incorporation of biomarker testing into clinical practice lags behind recommendations in National Comprehensive Cancer Network guidelines. Coverage policy differences across insurance health plans have limited the accessibility of comprehensive biomarker testing largely to patients whose insurance covers the recommended testing or those who can pay for the testing, and this has contributed to health disparities. Furthermore, even when insurance coverage exists for recommended biomarker testing, patients may incur burdensome out-of-pocket costs depending on their insurance plan benefits, which may also create barriers to testing. Prior authorization for biomarker testing for some patients can add an administrative burden and may delay testing and thus treatment if it is not done in a timely manner. Recently, three states (Illinois, Louisiana, and California) passed laws designed to improve access to biomarker testing at the state level. However, there is variability among these laws in terms of the population affected, the stage of cancer, and whether the coverage of testing is mandated, or the legislation addresses only prior authorization. Advocacy efforts by patient advocates, health care professionals, and professional societies are imperative at the state level to further improve coverage for and access to appropriate biomarker testing.

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“…Patients with lung cancer who receive next-generation sequencing (NGS) testing are twice as likely to participate in a clinical trial when compared with those who do not receive NGS; however, minority patients and Medicaid beneficiaries are less likely to receive NGS. [36][37][38] Unsurprisingly, Hispanic/Latinx are underrepresented in precision oncology clinical trials across tumor types; in lung cancer, Hispanic/Latinx represent only 1.02% of participants in oral oncolytic clinical trials leading to US Food and Drug Administration approval. 39 The shift toward precision oncology adds urgency to the need for policies and interventions that remove access barriers to biomarker and molecular testing to avoid perpetuating and broadening disparities in clinical trial accrual.…”

mentioning

confidence: 99%

“…Hispanic/Latinx individuals with cancer are less likely to undergo biomarker and molecular tumor testing, with rates of use close to 22% for the most common malignancies compared with > 30% among NHW. 36 With the increasing discovery of novel biomarkers and therapeutic targets, the number of biomarker-driven or molecularly driven clinical trials also has increased, serving as a gatekeeper to the enrollment of vulnerable groups who have decreased access to biomarker and molecular testing. A clear example is seen in lung cancer care.…”

mentioning

confidence: 99%