CMS made two groundbreaking decisions, in 2018 and 2020, respectively, that support the use of next generation sequencing (NGS) for patients with a late stage cancer diagnosis in the U.S. As these regulations expanded in 2020, we designed a study to determine the extent to which community oncologists applied the CMS policies and ordered next generation sequencing (NGS) for their eligible patients. We abstracted data from progress notes, pathology reports, NGS reports, and other related documentation in a community oncology practice of eight oncologists to determine if eligibile patients’ tumors were sequenced.
Eligible patients included:
Medicare eligible (over the age of 65)
Actively being treated at the respective cancer center
Stage III or IV disease
Diagnosis of lung, colon, prostate, pancreatic, breast, renal, gastric, esophageal, bladder, ovarian cancer,
These criteria yielded a sample of 199 patients.
Conclusions: Adoption of NGS Testing in the Community Oncology Setting
Our study revealed low compliance rates for NGS
testing in eligible patients.
of eligiblepatients receivedNGS testing
Potential Reasons for the Delay
in Uptake of NGS Testing:
Testing is still relatively new
CMS announced various NGS approvals
as recently as 2018 and 2020.
Interpreting results is challenging
Complex, lengthy and complicated
results require significant time to interpret.
Testing is not easy to do
Determining patients eligibility in real-time
is beyond provider capability.
Limited knowledge of NGS among providers
Existing workload and rapid advancement
prevent oncologists from having the necessary
time to thoroughly understand NGS testing
and available targeted therapies.
NGS Testing by Disease Site
Gastric Cancer had the
highest compliance with 80%
NGS Testing by Provider
Individual provider practice behaviors, the proportion of patients that had NGS
results ranged from 23.3% to a
high of 73.3% eligible patients
Experience of Next Generation Sequencing in the Medicare Eligible Cancer Patient Population: Community Oncology Practice in Response to CMS Next Generation Sequencing Policy
August 7, 2020
Devan Birch, BS, Jeni Huggins, RN, BSN, OCN,
Fred Ashbury, PhD
ORION by VieCure
Volume 1, Issue 2
Given the reasons indicated above, it is not surprising that we are seeing a 45% compliance rate, however, we believe that we can improve this behavior. It is obvious that oncologists cannot solve this complex problem themselves, they are going to need some help. If we, as a community, can provide clinicians with appropriate education, resources, and decision-support tools, then they will be equipped to optimize patient care and leverage CMS’s newly approved guidelines.