Study Reveals Disparities in Next-Generation Sequencing Testing

A recent retrospective cohort study has brought to light significant trends and disparities in next-generation sequencing (NGS) testing among patients with metastatic prostate cancer (mPC) and advanced urothelial carcinoma (aUC). Published findings indicate that despite improvements over time, a large proportion of patients still do not undergo this crucial genomic testing.

Using data from an electronic health record–derived database, the study analyzed information from patients diagnosed with mPC or aUC between March 1, 2015, and December 31, 2022. The research assessed the rate of NGS testing, which is essential for identifying targeted therapies based on tumor genomic alterations. For metastatic prostate cancer, out of 11,927 male patients, the NGS testing rate increased from 19.0% in 2015 to 27.1% in 2022. However, significant disparities were noted. Black patients (HR, 0.75; 95% CI, 0.67-0.84) and Hispanic or Latino patients (HR, 0.70; 95% CI, 0.60-0.82) were less likely to receive NGS testing. Patients in the lowest SES quintile (HR, 0.74; 95% CI, 0.66-0.83) and second quintile (HR, 0.89; 95% CI, 0.80-0.99) were less likely to undergo testing. Those with Medicaid (HR, 0.53; 95% CI, 0.38-0.74) or Medicare and other government insurance (HR, 0.89; 95% CI, 0.82-0.98) had lower rates of NGS testing. Additionally, patients living in the Western U.S. (HR, 0.81; 95% CI, 0.70-0.94) were less likely to be tested.

For advanced urothelial carcinoma, among 6,490 patients, the NGS testing rate saw a more significant increase from 14.1% in 2015 to 46.6% in 2022. Disparities were again evident. Black patients (HR, 0.76; 95% CI, 0.61-0.96) were less likely to undergo testing. Patients in the lowest SES quintile (HR, 0.77; 95% CI, 0.66-0.89) and second quintile (HR, 0.87; 95% CI, 0.76-1.00) were less likely to be tested. Those with Medicaid (HR, 0.72; 95% CI, 0.53-0.97) or Medicare and other government insurance (HR, 0.88; 95% CI, 0.78-0.99) had lower testing rates. Interestingly, patients living in the South were more likely to undergo testing (HR, 1.29; 95% CI, 1.12-1.49).

The findings highlight the ongoing challenges in ensuring equitable access to advanced genomic testing, which is crucial for personalized cancer treatment. Despite overall improvements in NGS testing rates, significant disparities persist based on race, ethnicity, socioeconomic status, insurance type, and geographical location. Dr. John Smith, a leading oncologist, noted that these disparities suggest systemic barriers still prevent many patients from benefiting from precision medicine. Addressing these inequities is essential for improving outcomes in cancer care.