Experience of Next Generation Sequencing in the Medicare Eligible Cancer Patient Population: Community Oncology Practice in Response to CMS Next Generation Sequencing Policy

Aug. 7, 2020

ORION by VieCure

Volume 1, Issue 2

Devan Birch, BS, Jeni Huggins, RN, BSN, OCN, Fred Ashbury, PhD

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.



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