Implementing a Precision Medicine Strategy to Improve Cancer Care

To effectively treat a disease as complex as cancer, the healthcare industry has recognized the need to tailor therapeutic approaches to individual patients – a method commonly known as precision medicine.

Providing cancer patients with personalized treatment plans can lead to better outcomes and improved survival rates, an advantage over current standard cancer therapies.

At Karmanos Cancer Institute, an NCI-designated comprehensive cancer center located in Detroit, Michigan, precision medicine treatments have become standard.

When implementing the precision medicine approach, Karmanos researchers knew that educating providers on the potential of molecular testing was a critical first step.

“In any institution or healthcare system, or even in practice, you have to redefine what the culture is for a particular approach. In medicine, we're really good at creating guidelines for best practices. In precision medicine or precision oncology, it's a little gray in terms of the guidelines that should be considered because it's a new and emerging field,” Elisabeth Heath, MD, associate center director for translational science at Karmanos, told HealthITAnalytics.

“You're trying to determine how testing can help define treatments and approaches for individual patients. So, in shifting towards standardization of these types of molecular testing, we had to get everybody to understand the value of using these methods – not just physicians, but also those involved in the care planning of patients.”

Karmanos leaders took great care to get providers on board with molecular testing and precision medicine, and have since seen successful results, Heath noted.

“We now conduct molecular testing, or at least offer molecular testing, for patients with advanced or metastatic disease to get a molecular profiling,” she said.

“As time has gone on, we've tried to figure out a new process for identifying other high-risk groups. Part of that is determining how we can deploy molecular testing earlier in care settings.”

One key barrier to implementing precision medicine strategies is deciding who will conduct the molecular testing, which is both more complicated and more expensive than other routine tests.

“We're used to just plain blood work, where patients stick out their arms and providers take out the blood. That was the first level of testing to figure out how patients were doing, and we’ve had to incorporate that into our daily workflow. If you substitute out the blood test and now you have to have a tissue sample, the first thing you have to determine is how to get the tissue sample and where to biopsy,” Heath said.

“You also have to figure out if it will require anesthesia. Additionally, once you do that, you have to know whether the pathologist knows what you need, and how to send it off to the company you're working with. All of this ends up involving multiple people in a health system or in a practice, and if you miss any one of those points, it's really hard to get the right data at the end of it.”

Insurance also plays a major role in precision medicine implementation, Heath stated.

“If you send the material and your insurance doesn't cover it, then patients might be responsible for the costs. And these are not cheap tests – sometimes they range in thousands of dollars,” she said.

“It took us about a year to get this all set up. When we first started, we figured out that there are maybe 40 to 50 different touch points in an organization for this particular thing to go well, which is a lot of people. That can be a barrier.”

Overcoming these barriers will first require healthcare leaders to secure buy-in from their colleagues.

“I, as one practicing physician, can't speak for an entire health system without doing my own homework. If we want to be successful, we have to identify this as something of great value for the organization, and then get folks that are part of this process to be educated on it. Because if you keep trying to get this done as a one-person mission, is doomed to fail. There are many, many folks that need to understand the process, especially from a patient standpoint,” said Heath.

“Even on a patient level, we have to educate them and make sure that they know what they're signing up for, so there are no surprises. Although the mission and the vision of getting precision medicine is top of mind, you have to figure out a way to translate that information and implement it successfully. And that takes a lot of detailed work and time.”

For organizations looking to implement precision medicine strategies, learning from others’ experiences will help tremendously.

“Don't reinvent the wheel. There are already many organizations that do it well, and there are organizations that have the means to do their own testing. They have their own workflow because they have laboratories, experts, and ways of putting this data into their own medical records,” Heath said.

“If that is something that you want to do for your own health system, talk to the person that's already done it because they've worked through all of the steps. See what they've learned and find out what you can leverage for your own group.”

In institutions where internal resources are limited, partnerships offer an effective solution.

“We developed a partnership with one of the companies that goes beyond just testing. We figure out what the next question is from a research standpoint, so that we can learn and potentially make inroads into another type of question important in cancer,” Heath stated.

Ultimately, the success of precision medicine will hinge on the ability to improve patient care.

“Although precision medicine is a relatively new area, the idea is the same: We want to see what we can identify from the patient's cancer so that we can provide the best care. Sometimes when we talk about stuff like this, people get too hung up on the actual technology and not what the big gain is. And the big gain is how we can help serve patients,” Heath concluded.

“For folks who are interested in implementing precision medicine for the first time, as long as the patient is top of mind everybody's going to be on the right path.”