Genomic Testing Uptake Among Medicare Beneficiaries With Cancer

Area of Science:

• Oncology
• Genomics
• Health Services Research

Background:

• Genomic testing is crucial for precision oncology, guiding targeted therapies.
• Medicare established national coverage determinations (NCDs) for next-generation sequencing (NGS) in 2018 and 2020.
• Population-level adoption patterns of genomic testing among Medicare beneficiaries require examination.

Purpose of the Study:

• To examine trends and variations in the uptake of NGS and non-NGS genomic testing.
• To assess genomic testing patterns among Medicare beneficiaries with common cancers.

Main Methods:

• Retrospective cohort study of Medicare fee-for-service beneficiaries (≥66 years) from 2016-2023.
• Identified beneficiaries with incident lung, breast, colorectal, prostate, or endometrial cancer.
• Analyzed receipt of genomic testing within 180 days of diagnosis, using multivariable logistic regression.

Main Results:

• Genomic testing nearly tripled from 6.0% in 2016 to 16.7% in 2023; NGS adoption increased modestly.
• Beneficiaries with lung cancer showed the highest NGS uptake (1.6% to 9.2%), while breast cancer saw increased non-NGS testing.
• Prostate cancer patients had the lowest genomic testing uptake; uptake varied significantly by cancer type and geographic location.

Conclusions:

• Genomic testing, particularly NGS, increased post-NCD implementation, especially for lung cancer.
• Non-NGS testing increased for breast cancer without a parallel rise in NGS.
• Modest overall NGS uptake highlights ongoing challenges in accessing precision oncology diagnostics.