Barriers to the use of personalized medicine in breast cancer

Christine B. Weldon, Julia R. Trosman, William J Gradishar, Al B Benson III, Julian C. Schink*

*Corresponding author for this work

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose: Personalized medicine - the use of genomics and molecular diagnostics to direct care decisions - may improve outcomes by more accurately individualizing treatment to patients. Using qualitative research, we explored care delivery barriers to the use of personalized medicine for patients with breast cancer using examples of BRCA and gene expression profile testing. Methods: We conducted 51 interviews with multidisciplinary stakeholders in breast cancer care: clinicians (n = 25) from three academic and nine nonacademic organizations, executives (n = 20) from four major private insurers, and patient advocates (n = 6). Results: Barriers were common to the BRCA and gene expression profile tests and were classified under two categories: poor coordination of tests relative to treatment decisions and reimbursement-related disincentives. Perception of specific barriers varied across groups. Difficulty coordinating diagnostics relative to decisions was the most frequent concern by clinicians (60%), but only 35% of payers and 17% of advocates noted this barrier. For 60% of payers, drug- and procedure-based reimbursement was a significant barrier, but only 40% of clinicians and none of the advocates expressed the same concern. The opinion that patient out-of-pocket expenses are a barrier varied significantly between advocates and clinicians (83% v 20%, P < .007), and advocates and payers (83% v 15%, P < .004). Barriers were reported to result in postponement or avoidance of tests, delayed treatment decisions, and proceeding with decisions before test results. Conclusion: Poorly coordinated diagnostic testing and the current oncology reimbursement model are barriers to the use of genomic and molecular diagnostic tests in cancer care.

Original languageEnglish (US)
JournalJournal of Oncology Practice
Volume8
Issue number4
DOIs
StatePublished - Jul 1 2012

Fingerprint

Precision Medicine
Breast Neoplasms
Molecular Pathology
Transcriptome
Insurance Carriers
Qualitative Research
Health Expenditures
Genomics
Routine Diagnostic Tests
Motivation
Therapeutics
Organizations
Interviews
Pharmaceutical Preparations
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Weldon, Christine B. ; Trosman, Julia R. ; Gradishar, William J ; Benson III, Al B ; Schink, Julian C. / Barriers to the use of personalized medicine in breast cancer. In: Journal of Oncology Practice. 2012 ; Vol. 8, No. 4.
@article{8debdad6f23f43358c40236201b81a80,
title = "Barriers to the use of personalized medicine in breast cancer",
abstract = "Purpose: Personalized medicine - the use of genomics and molecular diagnostics to direct care decisions - may improve outcomes by more accurately individualizing treatment to patients. Using qualitative research, we explored care delivery barriers to the use of personalized medicine for patients with breast cancer using examples of BRCA and gene expression profile testing. Methods: We conducted 51 interviews with multidisciplinary stakeholders in breast cancer care: clinicians (n = 25) from three academic and nine nonacademic organizations, executives (n = 20) from four major private insurers, and patient advocates (n = 6). Results: Barriers were common to the BRCA and gene expression profile tests and were classified under two categories: poor coordination of tests relative to treatment decisions and reimbursement-related disincentives. Perception of specific barriers varied across groups. Difficulty coordinating diagnostics relative to decisions was the most frequent concern by clinicians (60{\%}), but only 35{\%} of payers and 17{\%} of advocates noted this barrier. For 60{\%} of payers, drug- and procedure-based reimbursement was a significant barrier, but only 40{\%} of clinicians and none of the advocates expressed the same concern. The opinion that patient out-of-pocket expenses are a barrier varied significantly between advocates and clinicians (83{\%} v 20{\%}, P < .007), and advocates and payers (83{\%} v 15{\%}, P < .004). Barriers were reported to result in postponement or avoidance of tests, delayed treatment decisions, and proceeding with decisions before test results. Conclusion: Poorly coordinated diagnostic testing and the current oncology reimbursement model are barriers to the use of genomic and molecular diagnostic tests in cancer care.",
author = "Weldon, {Christine B.} and Trosman, {Julia R.} and Gradishar, {William J} and {Benson III}, {Al B} and Schink, {Julian C.}",
year = "2012",
month = "7",
day = "1",
doi = "10.1200/JOP.2011.000448",
language = "English (US)",
volume = "8",
journal = "Journal of Oncology Practice",
issn = "1554-7477",
publisher = "American Society of Clinical Oncology",
number = "4",

}

Barriers to the use of personalized medicine in breast cancer. / Weldon, Christine B.; Trosman, Julia R.; Gradishar, William J; Benson III, Al B; Schink, Julian C.

In: Journal of Oncology Practice, Vol. 8, No. 4, 01.07.2012.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Barriers to the use of personalized medicine in breast cancer

AU - Weldon, Christine B.

AU - Trosman, Julia R.

AU - Gradishar, William J

AU - Benson III, Al B

AU - Schink, Julian C.

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Purpose: Personalized medicine - the use of genomics and molecular diagnostics to direct care decisions - may improve outcomes by more accurately individualizing treatment to patients. Using qualitative research, we explored care delivery barriers to the use of personalized medicine for patients with breast cancer using examples of BRCA and gene expression profile testing. Methods: We conducted 51 interviews with multidisciplinary stakeholders in breast cancer care: clinicians (n = 25) from three academic and nine nonacademic organizations, executives (n = 20) from four major private insurers, and patient advocates (n = 6). Results: Barriers were common to the BRCA and gene expression profile tests and were classified under two categories: poor coordination of tests relative to treatment decisions and reimbursement-related disincentives. Perception of specific barriers varied across groups. Difficulty coordinating diagnostics relative to decisions was the most frequent concern by clinicians (60%), but only 35% of payers and 17% of advocates noted this barrier. For 60% of payers, drug- and procedure-based reimbursement was a significant barrier, but only 40% of clinicians and none of the advocates expressed the same concern. The opinion that patient out-of-pocket expenses are a barrier varied significantly between advocates and clinicians (83% v 20%, P < .007), and advocates and payers (83% v 15%, P < .004). Barriers were reported to result in postponement or avoidance of tests, delayed treatment decisions, and proceeding with decisions before test results. Conclusion: Poorly coordinated diagnostic testing and the current oncology reimbursement model are barriers to the use of genomic and molecular diagnostic tests in cancer care.

AB - Purpose: Personalized medicine - the use of genomics and molecular diagnostics to direct care decisions - may improve outcomes by more accurately individualizing treatment to patients. Using qualitative research, we explored care delivery barriers to the use of personalized medicine for patients with breast cancer using examples of BRCA and gene expression profile testing. Methods: We conducted 51 interviews with multidisciplinary stakeholders in breast cancer care: clinicians (n = 25) from three academic and nine nonacademic organizations, executives (n = 20) from four major private insurers, and patient advocates (n = 6). Results: Barriers were common to the BRCA and gene expression profile tests and were classified under two categories: poor coordination of tests relative to treatment decisions and reimbursement-related disincentives. Perception of specific barriers varied across groups. Difficulty coordinating diagnostics relative to decisions was the most frequent concern by clinicians (60%), but only 35% of payers and 17% of advocates noted this barrier. For 60% of payers, drug- and procedure-based reimbursement was a significant barrier, but only 40% of clinicians and none of the advocates expressed the same concern. The opinion that patient out-of-pocket expenses are a barrier varied significantly between advocates and clinicians (83% v 20%, P < .007), and advocates and payers (83% v 15%, P < .004). Barriers were reported to result in postponement or avoidance of tests, delayed treatment decisions, and proceeding with decisions before test results. Conclusion: Poorly coordinated diagnostic testing and the current oncology reimbursement model are barriers to the use of genomic and molecular diagnostic tests in cancer care.

UR - http://www.scopus.com/inward/record.url?scp=84870377686&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870377686&partnerID=8YFLogxK

U2 - 10.1200/JOP.2011.000448

DO - 10.1200/JOP.2011.000448

M3 - Article

VL - 8

JO - Journal of Oncology Practice

JF - Journal of Oncology Practice

SN - 1554-7477

IS - 4

ER -