Personalized Medicine and Future Delivery Systems

A panel of experts gathered recently to explore changes that are expected for oncology in the field of personalized medicine as well as their impact on future delivery systems. The panel discussion, held in November at the Cancer Center Business Summit, highlighted what appears to be a gap between the medical community and companies that provide testing for personalized medicine. At the same time, the panelists agreed that available data and information relating personalized medicine to cancer treatment choices is not yet being used to full efficacy, which presents an untapped opportunity for cancer patients.

Moderated by Edward Abrahams, PhD, President, Personalized Medicine Coalition, the panel included Maurie Markman, MD, Senior Vice President for Clinical Affairs, Cancer Treatment Centers of America; Catherine A. McCarty, PhD, MPH, Principal Research Scientist, Essentia Health; Timothy Thompson, CEO, Intervention Insights; David Nixon, CEO, InformedDNA; and Christine Cournoyer, CEO, N-of-One.

The panelists presented their own perspectives and debated several questions, including the following: Who will become the interpreter of evidence as well as the arbiter of acceptable or covered treatments? Will personalized testing on a large scale be allowed or required, and at what thresholds for pricing? Will physicians change their treatment choices based upon the results of these tests? When do the tests change the dynamic of the oncologist–patient interaction? Will cancer care reach a point where personalized testing, rather than the oncologist, drives and determines approved therapies?

Other points that were raised included the following: Will pharmaceutical manufacturers move away from a payer coverage–physician acceptance paradigm for therapies in favor of identifying specific biomarkers and determining how arbiters interpret results and value? Does the speed at which personalized markers and tests are evolving impact the definition of “evidence” within evidence-based care choices? Are changes occurring so rapidly that most stakeholders will not be able to keep up?

During the discussion, Dr Markman identified precision medicine as the future of healthcare. The question, he stated, is not when data within this field will become available (much of it is available already), but rather how to sift through existing data to determine what is important and actionable. He suggested that the challenge will be in shifting the relevance of treatment from individual patients to groups of patients, and that a national registry of results might be one useful solution.

Dr McCarty shared her concerns about how to bring discoveries in cancer testing and therapy into rural healthcare. She described Essentia Health as the second largest healthcare delivery system in rural America, as well as a growing accountable care organization. She mentioned that as a member of the HMO Research Network—a consortium of provider and HMO organizations that have well-established research capabilities—Essentia Health is generating extensive amounts of data. The current challenge for the HMO Research Network is to build decision support tools and resources for physicians from the data, and to develop models to apply that data at the patient level.

Mr Thompson, as a representative of the organizations that provide personalized medicine testing, dem­onstrated how his team uses evidence and testing results to help physicians decide what treatments are appropriate to use with specific patients. Mr Nixon of Informed DNA commented that his team delivers both genetic testing counseling and decision support for patients and providers. He suggested that the majority of oncologists and surgeons who order genetic testing do not understand the implications and findings, and are not equipped to interpret them for patients or to assist with making treatment choices based on them. Mr Nixon noted that genetics professionals deserve a place in the physician decision process, and suggested that a key step to ensure the involvement of the counselors is for payers to require genetics services counseling.

Ms Cournoyer commented on the challenges that physicians and patients face, indicating that broader testing and guided therapy may provide alternatives to patients who are failing standard-of-care therapy. In addition, she noted that better integration of molecular testing has the potential to transform personalized cancer care. Ms Cournoyer shared that her company, N-of-One, has developed a partnership with Utah-based Intermountain Healthcare to offer personalized molecular testing and counseling to patients and bring the results to Intermountain Healthcare tumor boards for discussion.

The general consensus among panelists was that the role of external companies that provide testing and offer counseling and guidance to both physicians and patients is growing and will continue to expand as personalized medicine evolves. This may have a significant impact on clinicians, pharmaceutical manufacturers, and patients with cancer.

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