While precision oncology has shown great promise, there are still barriers to its implementation, such as data fragmentation, staff shortages and time, funding, and lack of standardization
Use of efficient, easy-to-use, and integrated digital solutions are moving the needle in the adoption of precision oncology because they allow for reduced fragmentation of data, improved standardized care, and support clinicians in decision making
Digital solutions for precision oncology exist and can be made accessible through collaboration and investment from policymakers, healthcare providers, and researchers to improve access, data sharing, and education
This article is based on interviews conducted by Albino Troilo, PhD, and Sr. Portfolio Marketing Manager at Roche Information Solutions with precision oncology key opinion leaders Dr. Anthony Magliocco, Professor of Pathology at University of Central Florida, USA; Dr. Ming Huang-Chen, Professor of School of Medicine at National Yang-Ming Chiao-Tung University and Director of Medical Oncology Division at Taipei Veterans General Hospital, Taiwan; and Dr. Henning Schulze-Bergkamen, Head of the Center of Tumor Diseases at St. Mary Hospital in Wesel, Germany.
The life-saving potential of precision oncology
“My son is eighteen years old. They told me they cured his testicular cancer and not to worry about it. But it’s come back. Now it’s in his liver and his bones, and it looks like he’s dying. He can barely breathe. It’s growing so fast, and they can’t do anything. Is there something you can do to help?”
Dr. Anthony Magliocco, Professor of Pathology at University of Central Florida and precision oncology expert, received the above call from the mother of a cancer patient in Australia. Dr. Magliocco requested the patient’s molecular testing results, only to learn that molecular testing was never performed.
After weeks of jumping through hoops to collect samples from the patient, Dr. Magliocco performed a next-generation sequencing (NGS) analysis of the tumor sample and, with the support of specific digital solutions, was able to quickly identify several actionable genomic mutations and four clinical trial options that would be suitable for the patient.
The patient’s doctor in Australia needed to be convinced about the novel treatment options, initially suspecting Dr. Magliocco to be “an unreputable doctor in America.” The two doctors spoke and conducted a virtual tumor board to review the detailed results, and eventually, the patient was enrolled in a clinical trial in France.
Six months later, the patient’s mother called Dr. Magliocco with an update. “We went for a scan last week, and he’s totally cancer free. The cancer’s completely gone. It’s just nothing. None of it’s left at all. And he’s back at college, playing sports again, and it’s just a miraculous cure.”
Overjoyed at the news, Dr. Magliocco shared that all he did was what he believed should be the standard for every patient. Precision oncology made possible this young Australian patient’s positive outcome. It is a paradigm shift in cancer treatment that not only improves patient outcomes and alters the trajectory of their illness, but also saves them from unnecessary toxicity and reduces healthcare costs from unneeded treatments.1,2
In spite of these benefits, precision oncology continues to be a privilege to which a select few have access.
The current state of precision oncology: A gap in the implementation process
Precision oncology is at an inflection point worldwide as we move away from a one-size-fits-all approach towards tailored treatments for individual patients. From a scientific and technological standpoint, tremendous advances have been made, with several targeted therapies approved.3 According to Dr. Henning Schulze-Bergkamen, Head of the Center of Tumor Diseases at St. Mary Hospital in Wesel, Germany, genomic profiling for cancer diagnosis and treatment for certain tumor types is already commonplace in many parts of the world, including Germany, however, the implementation of this practice still faces many challenges.
Dr. Magliocco shared that more than 80 percent of patients in community practice in the United States are not getting access to the latest guideline-based precision therapies and targeted treatments, and not getting the opportunities to enroll in clinical trials. Access is even less in rural and low-income communities in the United States.4
Dr. Ming-Huang Chen, professor at the School of Medicine at National Yang-Ming Chiao-Tung University and Director of Medical Oncology Division at Taipei Veterans General Hospital, Taiwan, explained that in the Asia Pacific Region, precision oncology has taken off mainly in Japan and Korea because it is reimbursed by the government. In Taiwan and other countries in Asia, on the other hand, most patients engaged in precision oncology hold private insurance because the government does not yet reimburse for it, and this makes it difficult for this practice to be widely adopted.
Why the slow implementation of precision oncology?
While the science and technology behind precision oncology have shown immense promise, there are still barriers to its adoption in clinical practice.
Lack of awareness
Among various healthcare stakeholders, there is a lack of understanding and educational resources on the clinical utility of precision oncology. Oftentimes, neither clinicians nor payers have a clear understanding of biomarker tests or how to interpret them. As a result, payers and clinicians often place the blame on each other for issues in implementation, which has contributed to slow adoption.
Multidisciplinary team collaboration and data fragmentation
Precision oncology involves treating the patient based on complex, multimodal data from multiple sources. The analysis of all that data requires the expertise of a multidisciplinary team. In both the United States and Germany, leading academic or excellence centers are using precision oncology, but outside of integrated care settings, the members of the multidisciplinary oncology care team are often in different places and not effectively communicating with one another.
Across all geographic regions, different hospitals use different electronic medical record systems, which makes it challenging to share and compare data across healthcare providers and institutions. Dr. Ming-Huang Chen shared, “In Taiwan and China data-sharing capacity is limited because of patient protection regulations. In Taiwan, we cannot allow other people outside the hospital to touch the information. If we blind all patient information, maybe the Institutional Review Board would allow us to share the information. However, in real-world clinical practice, that would be a big issue.” Data fragmentation and lack of communication make precision oncology harder to implement.
Staff shortages and time
“With the current healthcare staff shortage crisis, physicians, especially generalist oncologists, are limited in their time to provide precision oncology. If you’re a specialist in lung cancer, there’s a new test coming out on a weekly or monthly basis. It’s extremely hard to keep up. But if you’re a generalist, it’s almost impossible.”
Anthony Magliocco, Prof. MD FCAPProfessor of Oncology and Pathology at University of Central Florida, CEO of Protean BioDiagnostics
Healthcare systems across the world are facing severe staff shortages.5 The World Health Organization (2022) estimates that there will be a worldwide shortage of 10 million healthcare workers by the year 2030.6 This can have a tremendous impact on cancer patients.
Dr. Magliocco stated, “With the current healthcare staff shortage crisis, physicians, especially generalist oncologists, are limited in their time to provide precision oncology. If you’re a specialist in lung cancer, there’s a new test coming out on a weekly or monthly basis. It’s extremely hard to keep up. But if you’re a generalist, it’s almost impossible.” With the complex and vast amount of data that precision oncology produces, physicians may lack the time to interpret the data and filter out what is most relevant.
Another barrier is the amount of time it takes to get the results of genomic testing and identify a targeted therapy for the patient. Not acting quickly can result in not being able to act at all. Dr. Chen shared his experience, “If they can afford it, I always persuade my patients to do genomic testing to access targeted therapy as early as we can if they are metastatic or have unreceptive cancer. If we’ve failed standard treatment, we don’t have another treatment choice. At that moment, when we start to persuade the patient to do genomic testing, we have to wait three to four weeks to get the genomic data, analyze them, and find a potential targeted therapy, and the patient has already passed away or is too weak to receive treatment.”
Lack of standardization
Clinical practice guidelines in oncology are heterogeneous, and the lack of a standardized approach represents a barrier to precision oncology implementation. Dr. Magliocco says, “It is difficult to keep up with growing medical knowledge, such as new drugs, clinical trials, scientific research, and guidelines whose length and complexity continue to grow. On top of that, not every oncologist has the same confidence in genomic testing and data interpretation. This leads to patients being under-tested, which could lead to missing treatment opportunities for the patient, or over-tested, leading to confusion and delays in the treatment.”
There is no country that we know of that has standard guidelines for precision oncology, and there is no obligatory type of testing that must be done and software tools that must be used. Dr. Chen commented that in clinical practice in Taiwan, the European Society for Medical Oncology (ESMO) or National Comprehensive Cancer Network (NCCN) guidelines are commonly referenced as the standard for recommended testing in cancer treatment.
In the United States, payors set the guidelines for the tests and treatments they cover. According to Dr. Magliocco, Medicare typically sets the standards, and private payors follow Medicare’s lead on what should be reimbursed. The biggest reasons for the lack of standardizations are:
Existing approved treatments are not being used by everyone in a consistent way because the guidelines are not mandatory, and
Novel approved drugs that are not reimbursed are not often considered.
In Germany, however, Dr. Schulze-Bergkamen believes that there is promise in addressing the issue of standardization with the trend towards requiring certification for cancer centers.
Funding
Implementing new tools and methodologies costs money. Reimbursement is one of the greatest barriers worldwide facing access to precision oncology. Some physicians are not inclined to perform tests for which patients will not be reimbursed.
Dr. Schulze-Bergkamen explained, “It is our daily practice to check reimbursement strategies and convince payors to get all diagnostic procedures and therapies reimbursed.” And Dr. Chen added, “The situation in Taiwan is such that there are no copays, however, the government does not have enough of a budget to cover genomic testing for all cancer patients. Nonetheless, it is encouraging to see that the Taiwanese government is starting to recognize the importance of precision oncology for cancer diagnosis and treatment and is providing grants for free comprehensive genetic and genomic testing starting with lung cancer.”
Dr. Magliocco shared that in the United States, a considerable number of patients are uninsured, with rates as high as 18% in certain states.7 The lack of coverage represents a big barrier to access to precision oncology, as targeted therapies are often very expensive leading to a “financial toxicity”, a financial burden that patients face due to the cost of medical care.8
Addressing the barriers: Moving the needle with digital solutions
“By using digital tools, physicians can access patient data in real-time, facilitating interdisciplinary collaboration and improving patient outcomes. For instance, advanced analytics tools can help identify biomarkers and treatment options that might be overlooked due to data complexity. As such, digital tools provide solutions to the barriers to precision oncology implementation.”
Ming Huang-Chen, Prof. MDDirector, Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
“The future of healthcare is inextricably linked with digital transformation. As we consider the current state of precision oncology and the barriers to implementation, we must look towards digitization to move forward,” said Dr. Magliocco.
Digital tools are useful because they provide efficient data collection and processing, enhance data interoperability, and support sharing and collaboration, all of which are crucial for precision oncology. “By using digital tools, physicians can access patient data in real-time, facilitating interdisciplinary collaboration and improving patient outcomes. For instance, advanced analytics tools can help identify biomarkers and treatment options that might be overlooked due to data complexity. As such, digital tools provide solutions to the barriers to precision oncology implementation”, added Dr. Chen.
How digital solutions address multidisciplinary team collaboration and data fragmentation
Digital solutions that support molecular tumor boards are one concrete example of how we can overcome data fragmentation and team collaboration. They play an important role in precision oncology adoption because they enable multidisciplinary oncology care teams to provide quicker treatment decisions through integrated and standardized data.9
Without the support of a digital platform, tumor boards can be labor intensive and add additional administrative burden. For instance, navigating multiple systems to collect and review patient data, multidisciplinary oncology care teams can lose time and focus from achieving consensus on patient treatments.
Dr. Magliocco, who is using digital solutions to run molecular tumor board meetings, stated, “Digital solutions are extremely helpful for cases where we are looking for targeted therapies. They allow us to integrate data from multiple platforms (molecular, immunohistochemistry, fluorescence in situ hybridization, next-generation sequencing, etc.), they facilitate case discussion among the oncology care team, and they save time in making clinical decisions.”
Dr. Schulze-Bergkamen adds, “With digital tools supporting our molecular tumor boards, we are able to join forces regionally and nationally in a network of different IT systems and process patient cases in a standardized manner.”
In describing what an advanced molecular tumor board digital tool could look like, Dr. Chen commented that it can “display patient data as a patient journey. This timeline format presents all of the patient’s relevant medical information, from diagnosis to treatment, allowing physicians to better understand the patient’s disease progression and tailor treatment accordingly.”
How digital solutions address staff shortages and time
With digital solutions, tasks and analyses that previously would have to have been done manually can be automated, freeing up more healthcare professionals’ time for patient care.10,11 Examples of administrative tasks that digital solutions can streamline include patient scheduling, record keeping, and patient management.
“Having a digital tool that is able to identify clinical trials for specific patients saves physicians time and energy. This is particularly relevant for local clinical trials that do not have global exposure and that might be the best options for our local community.”
Henning Schulze-Bergkamen, Prof. MDHead of the Department of Internal Medicine, St. Mary Hospital in Wesel, Germany
Digital solutions can serve the purpose of documenting care and can make it easier for professionals to keep up with rapidly growing medical information, which is doubling approximately every 73 days.12 Another important advantage of digital solutions is to easily identify actionable genomic mutations from NGS data and suitable clinical trials for a patient. “Having a digital tool that is able to identify clinical trials for specific patients saves physicians time and energy. This is particularly relevant for local clinical trials that do not have global exposure and that might be the best options for our local community,” said Dr. Schulze-Bergkamen.
Dr. Magliocco also spoke of the potential of artificial intelligence in digital solutions and how this technology could help overcome staff shortages and reduce the time to diagnosis and treatment. “Artificial intelligence can make predictions about mutation status without sequencing. And it may be able to diagnose and classify tumors more rapidly than humans. It can also improve the ability of oncologists to integrate data so we can have a level playing field for a higher quality of care. Because right now, your outcome is only as good as your oncologist,” he said.
How digital solutions address the lack of standardization
Currently, different healthcare settings have different procedures for testing and treatment. With digital solutions, uniform standards can be clearly laid out for healthcare professionals, with recommendations on which patients should receive which type of testing and if they may be eligible for targeted therapies based on the results. Digital solutions make it easy to review up-to-date clinical guidelines and pathways to support evidence-based treatment planning and standardization of care, gain real-time insights, and automate guideline adherence reporting to support reimbursement and accreditation.
From dream for a few to reality for all
We are moving from a one-size-fits-all approach to cancer care to optimized treatment for individual patients, which leads to better outcomes and lower healthcare costs. While there are still numerous barriers in place that prevent precision oncology from being commonly implemented rather than a dream only available to a select few, digital solutions have demonstrated that these barriers can be broken.
Digital solutions are critical in the implementation of precision oncology because they are able to track the entire patient journey from diagnosis to complete remission with all the data, including imaging, in one place. Moreover, they support education and research, and they represent the foundation of personalized medicine.
It is because of a precision oncology approach supported by digital tools that a young boy in Australia who was previously told he only had months left to live is now thriving in university. Precision oncology and digital solutions not only add years to life, but life to years.
The widespread adoption of digital solutions will require collaboration and investment from policymakers, healthcare providers, and researchers to improve access, data sharing, and education around precision oncology. As we move towards the use of digital solutions, it is important to implement those solutions that are scalable and flexible, constantly monitor patient outcomes, and use caution with patient data.
Dr. Schulze-Bergkamen said, “If there’s a molecular alteration, I want to put it in a decision tool and get results on the relevance of this alteration with respect to the therapy decision. That’s the tool I want. And a tool that would help me get rapid access to longitudinal patient data, guidelines, therapy options, and clinical trials near our hospital.”
Such solutions exist. Now is the time to implement them.
Actionable insights for precision oncology implementation with digital solutions
Implement evidence-based, easy-to-use, accurate and efficient solutions that are interoperable with current electronic medical records (EMRs) and laboratory information system (LIS) solutions, as well as scalable and flexible
Select solutions that enable you to do quality assurance, utilization metrics, education and research
Ensure to be compliant with patient data protection laws and regulations by collecting, storing, and transmitting patient data securely
Partner with a reputable and experienced provider of healthcare digital solutions
by Ming Huang-Chen, Henning Schulze-Bergkamen, Anthony Magliocco, Albino Troilo
Henley et al. (2022). Article available from https://www.theguardian.com/society/2022/dec/14/a-ticking-time-bomb-healthcare-under-threat-across-western-europe [Accessed January 2023]
World Health Organization. (2021). Report available from https://www.who.int/health-topics/health-workforce#tab=tab_1 [Accessed January 2023]
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Anthony Magliocco, Prof. MD FCAPProfessor of Oncology and Pathology at University of Central Florida, CEO of Protean BioDiagnostics
Ming Huang-Chen, Prof. MDDirector, Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
Henning Schulze-Bergkamen, Prof. MDHead of the Department of Internal Medicine, St. Mary Hospital in Wesel, Germany
