Even though researchers are making progress every day, the precision medicine approach to cancer treatment is not yet part of routine care. Another strategy that can contribute to more personalized medicine is the tracking and subsequent use of clinical data in care decisions. Advanced tracking tools may be able to collect and display valuable data to clinicians for use in real-time decisions rather than weeks or months down the line retrospectively. Articles in this issue examine where we are with biomarker tracking in some populations and explore the use of prospective data tracking tools.
Biomarker-driven therapies are quickly becoming the gold standard of treatment in lung cancer. Recent studies suggest a higher prevalence of specific targetable biomarkers among Hispanic/Latinos than non-Hispanic whites. Using a 25-item survey, Teresita Muñoz-Antonia, PhD, and colleagues sought to (1) identify Florida and Puerto Rico physicians’ knowledge and perceived value of newer genomic data regarding race/ethnicity in relation to optimal lung cancer treatment and survival; and (2) identify modifiable practice barriers both across and within each location regarding biomarker testing in lung cancer. Differences were noted concerning physician’s preferences for ordering mutation testing, indicating a clear need for education in both locations.
The Veterans Health Administration is the largest nationally integrated health care delivery system in the United States, making it an ideal environment for development of tools designed to streamline cancer diagnosis and treatment. Head and neck cancer squamous cell carcinoma remains a difficult disease to diagnose and treat. Caroline Hudson, MD, and colleagues developed a prospective tracking tool available to providers and clinic staff to track patients from initial referral through diagnosis and treatment completion and used it to evaluate clinical care delivery between June 2016 and October 2018. Utilization of the tracking tool and closed-loop communication facilitated rapid treatment initiation and delivery. Compliance with treatment package time <100 days was 88%; compliance with initiation of adjuvant radiation within 6 weeks of surgery was 75%.
In his column this month, Ira Klein, MD, MBA, FACP, expands the precision medicine discussion beyond screening and treatment and into the value assessment realm. The health care insurance world has high-deductible health plans with health savings accounts as one of its fastest growing benefit designs. They feature “choice” in the form of economic carrots and sticks for selecting and paying for certain services, presumably also related to personal habits and preferences. Some of these offerings, including provider network services, have themselves contracted with the same health insurance company for condition management pathways programs, deployed at an individual and population level. But few of these pathway programs, he says, have analogous habits and preferences integrated in their metrics in the form of appealing to what values matter to individual patients beyond population level measures of quality and outcomes in a value-based contract.
