TOPLINE

Genomic testing among Medicare beneficiaries with cancer nearly tripled between 2016 and 2023, but absolute rates of testing — especially next-generation sequencing (NGS) — remain low.

METHODOLOGY

• Genomic testing is essential for guiding targeted therapies for patients with cancer, but access remains uneven. In March 2018, the Centers for Medicare & Medicaid Services implemented a national coverage determination for NGS in oncology care, but population-level adoption of testing since then has been unclear.
• Researchers used Medicare fee-for-service claims data to identify just over 391,000 beneficiaries diagnosed with lung, breast, colorectal, prostate, or endometrial cancer from 2016 through 2023.
• The primary outcome was receipt of NGS testing within 180 days after the first cancer diagnosis claim, with secondary outcomes including any genomic testing and a shift from non-NGS to NGS testing.
• Multivariable logistic regression was used to estimate adjusted probabilities of receiving NGS testing, controlling for patient characteristics including age, sex, race and ethnicity, cancer type, rural-urban residence, and comorbidities.

TAKEAWAY

• Of the total patient population, 7% received non-NGS genomic testing only, 1.2% received NGS only, and 0.5% received both — leaving 91.4% with no genomic testing.
• Receipt of any genomic testing nearly tripled during the study period, from 6% in 2016 to 16.7% in 2023 — driven largely by growth in non-NGS testing. However, NGS-only use roughly doubled between 2021 and 2023, reaching 2.1%.
• Beneficiaries with lung cancer had the highest NGS uptake, increasing from 1.6% in 2016 to 9.2% in 2023 (P < .001). Meanwhile, those with breast cancer had the highest rate of any genomic testing, reaching 28.6% in 2023, followed by patients with lung cancer (23.1%).
• Any genomic testing rose over time among patients with colorectal cancer (from 7.6% to 18.6%) and endometrial cancer (from 5.2% to 17.1%); NGS testing also increased but remained low in 2023, at 2% of patients with either cancer. Patients with prostate cancer had the lowest uptake of any genomic testing (fluctuating between 2.8% and 5.1%), with NGS use remaining below 1%.
• In adjusted analyses, the largest increase in NGS testing probability was seen among patients with lung cancer, reaching 5.6 percentage points — likely reflecting, the authors noted, “clear guidelines” calling for somatic NGS in patients with non-small cell lung cancer.

IN PRACTICE

“Overall, NGS uptake remained modest, highlighting persistent gaps in access to precision oncology testing,” the study authors wrote. They noted that even among patients with lung cancer, who were most likely to receive NGS, “uptake was well below guideline expectations.”

Further research is needed to understand the ongoing barriers to testing and to assess whether expanding NGS adoption ultimately improves patient outcomes, they concluded.

SOURCE

The study, led by So-Yeon Kang, PhD, MBA, MPH, of Georgetown University School of Health in Washington, DC, was published online in JAMA Network Open.

LIMITATIONS

Claims data lacked detailed clinical information, limiting the ability to evaluate clinical appropriateness for genomic testing. Results reflect Medicare fee-for-service beneficiaries and may not generalize to patients with Medicare Advantage or commercial insurance. Genomic testing claims were frequently billed by independent laboratories rather than treating institutions, limiting the ability to attribute testing to specific care settings.

DISCLOSURES

The study was supported by the National Institute for Health Care Management Foundation. Kang disclosed receiving grants from Arnold Ventures, the American Society of Clinical Oncology, and the National Cancer Institute outside the submitted work and receiving fees from the Colorado Consumer Health Initiative, Genentech, and Garner Health. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.