Precision Medicine Stewards: The Next Step in Personalized Medicine

Biomarker testing, once a futuristic concept with little place in daily practice, has become a fundamental driver in precision medicine and an integral component in cancer diagnostics and optimized care delivery. Recent years have seen a dramatic increase guideline-concordant biomarker test ordering, as well as a significant increase in U.S. Food and Drug Administration (FDA) approval of biomarker-directed therapies and clinical trials. So it comes as no surprise that cancer programs and practices are clamoring for new ways to meet the demand of this complex testing. Enter precision medicine stewards, the next natural step in the evolution of personalized medicine and cancer diagnostics. A precision medicine steward—a dedicated navigator focused specifically on biopsy samples and biomarker testing processes and results—can make a daunting testing process incredibly efficient. 

The advantages are clear. With precision medicine stewards, test ordering processes for oncologists are simplified; turnaround times for send-out tests are shortened; coordination of logistics for tissue transportation and tracking are better managed; results reporting, particularly with integrated labs, are seamless; tracking biomarker testing metrics and identifying quality gaps are easier; management of insurance coverage, pre-authorizations, and potential out-of-pocket expenses are transparent. Beyond this, cancer programs and practices that treat underserved populations may face unique challenges around biomarker testing (e.g., patients who are uninsured or require financial assistance) and could benefit from dedicated precision medicine stewards, who can help patients overcome these barriers to access.

Defining the Role

Therefore, the real question cancer programs and practices are asking is: how do we get a precision medicine steward? Yet, beyond this, and potentially more critical are the answers to questions like:

• How do we define the role of precision medicine stewards to differentiate from other clinical nurse navigators or lay patient navigators? 
• How do we implement this role into our specific program or practice setting (e.g., community vs. academic)? 
• How can we measure success to justify the addition of this role to our cancer program or practice?

Precision Medicine Stewardship is an education initiative of the Association for Community Cancer Centers (ACCC) in partnership with the Academy of Oncology Nurse and Patient Navigators and American Society for Clinical Pathology that set out to explore the answers to these questions and more. Through a series of three focus groups—held in August 2022 with cancer programs that have either successfully implemented precision medicine stewards or are considering the addition of one—experts examined these issues on a theoretical and practical level. Topics discussed included defining essential tasks of stewards, feasibility, resources, and other challenges to implementation, including metrics that would not only measure success but justify the need/addition of this role.

The consensus: greater knowledge-sharing and best practices from effective precision medicine stewardship programs are needed, as well as metrics that can prove the utility and feasibility of the role as an important member of the multidisciplinary cancer care team. 

Lindsey Reed, BSN, MBA, RN, OCN, ONN-CG, division director of Navigation at Sarah Cannon Cancer Center – Kansas City in Missouri, participated in the focus groups and expressed a firm need for solid metrics and more data, which could go a long way in gaining buy-in from cancer programs and practices. “Really demonstrating that turnaround time and the decreased time that the patient can go from diagnosis to treatment, and it’s the right treatment for the patient—that’s a huge win for the patient. [Also] possibly comparing outcomes for patients once you’ve implemented this process, as well as looking at patient retention…[and] patient and physician satisfaction….” 

Courtney Rice, MS, licensed certified genetic counselor and manager of Precision Medicine and Genetic Services at TriHealth Cancer Institute in Ohio, which currently has a precision medicine test coordinator role in place, added additional ideas. “A time study to assess the amount of time that the lab team is currently working to troubleshoot these type[s] of orders and then also a time study from the clinical, especially the nursing time, where they are the ones maybe placing the orders in an outside portal, waiting on hold to troubleshoot things or do[ing] prior authorization if needed…might also help,” Rice said. “And that’s why our support came more from the clinical side, and that’s why it’s in the Precision Medicine Department because it was hard for the lab to justify the additional staffing. However, the lab has benefited because this coordinator role is taking and fielding some of the questions [and issues] that were previously going to the labs.”

Look out for an upcoming article in Oncology Issues in 2023 that will explore the focus groups’ discussions in greater detail and help inform a pathway to integrate precision medicine stewards in cancer programs and practices nationwide.

For more information on precision medicine and biomarker testing in oncology, visit the ACCC website. 

The Precision Medicine Stewardship education program is supported by AstraZeneca and Blueprint Medicines.