Molecular Testing in Underserved Communities
Working Group Charter
Molecular Cancer Testing in Underserved Communities
Work Product Category
Manuscript or Publication: Statement of clinical utility
Specific Aims for the Work Product
Perform comprehensive literature review of the current state of molecular diagnostics for cancer in communities across the United States, with focus on smaller cities, rural areas and underserved, resource-poor populations.
Provide specific examples or case vignettes of specific resource-limited communities and underserved populations in order to illustrate the current status of molecular oncology testing landscape in those communities, barriers to testing (such as regulatory and insurance coverage), and how limited access to such testing impacts patient outcome.
Describe how improved / enhanced local, in-house testing capability at community health centers would significantly improve health care and disease outcomes for local populations served by those health centers.
Discuss specific solutions to improve the current state of molecular testing in resource-limited communities, focusing on tests that can realistically be deployed and implemented in these communities and provide improvement in patient care.
In the US, about 80% of cancer patients live in small towns, rural areas, etc. and not near large medical centers with easy access to molecular testing. Data in 2021 shows that only 45% of lung cancer patients have the needed molecular tests to look for mutations in multiple genes (N. Robert et al., J Clin Oncol 39, 2021 (suppl 15; abstr 9004). Less than 20% of lung cancer patients receive appropriate molecular testing for relevant gene fusions, such as those involving ALK, ROS, RET and NTRK, all of which have important therapeutic implications. Moreover, studies have shown racial disparities in biomarker testing and clinical trial enrollment for non-small cell lung cancer (NSCLC). NGS-based testing, which is recommended by NCCN Guidelines for patients with advanced/metastatic NSCLC, has the most notable shortfall among black patients, with a greater than 10 percentage point disparity in receipt of this testing compared to white patients. We believe that studies to comprehensively and systematically evaluate the molecular testing landscape in resource-limited communities and in underserved populations are much needed. This information will provide important insights into existing problems and barriers to accessing appropriate testing, as well as potential solutions that would alleviate such challenges.
Working Group Members
Thuy Phung
University of South Alabama
Casey Brewer
Cincinnati Children's Hospital
Mei Ling Chong
Yale University
Ngonidzashe Faya
Cincinnati Children's Hospital
Katherine Geiersbach
Mayo Clinic
Felicia Gomez
Washington University
Joel Lefferts
Dartmouth-Hitchcock Medical Center
Erica Macke
Nationwide Children's Hospital
Honey Reddi
Medical College of Wisconsin
Niroshi Senaratne
University of California Los Angeles