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,
    or melanoma

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

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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

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Gastric Cancer had the
highest compliance with 80%

NGS Testing by Provider

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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.