Comprehensive Cancer Care: The Role of Biomarker Testing

Access to quality healthcare is strongly associated with patient treatment outcomes and survival of cancer. In a recent study by the American Cancer Society, Medicaid expansion was associated with an increase in critical palliative care for patients with advanced cancers. Yet, in another study of 7,000 patients with non-small cell lung cancer, Medicaid beneficiaries were 19% less likely to undergo biomarker testing compared to commercially insured patients and had a 27% higher risk of mortality compared to those who received testing.

Simply put, social drivers of health like insurance coverage or type can have a significant impact on patient’s access to precision medicine and comprehensive genomic profiling—which in turn impacts their treatment outcomes.

As of May 2023, 86 million individuals—nearly a quarter of Americans—are enrolled in Medicaid. Nationwide, the American Cancer Society estimates that 15% of patients with cancer under the age of 64 years are enrolled in Medicaid and at least 17% of adults under the age of 65 years were uninsured for at least part of the year.

With the expiration of the COVID-19 public health emergency earlier this year, scores of patients with cancer who were previously uninsured or unqualified for Medicaid are left without any sustainable means to continue their cancer care. Yet, despite this dire need impacting a significant population of the country, progress on Medicaid coverage for biomarker testing while steady, has been slow to catch up to the urgency of the situation.

Understanding the National Picture

In a recent article on the biomarker testing policy landscape, the Association of Community Cancer Centers (ACCC) highlighted the work that the American Cancer Society Action Network (ACS CAN), LUNGevity, and other advocacy organizations around the country are doing to help enact state legislation that would provide comprehensive biomarker testing coverage for all patients. To date, 12 states have passed such legislation and 10 more states were successful in introducing similar bills.

Now, advocacy leaders are working together to leverage state and local coalitions toward developing efforts that targets the issues relevant to a particular state and its legislative body. Brandon Leonard, MA, director of Government Affairs at LUNGevity Foundation, explains that for patient advocacy organizations without staff in every state, connecting with local partners within the states can be extremely powerful.

“In Maryland, we were able to connect to a local advocate who happened to be both a lung cancer survivor and a doctor herself. So, she was able to testify at the hearings in the State Assembly in the State Senate. I think for these hearings, to bring different perspectives together—a strong patient perspective and a provider perspective—has been key,” Leonard said.

Hilary Gee Goeckner, MSW, director of State and Local Campaigns at the American Cancer Society Cancer Action Network, describes the power of local coalition building with this. “Bringing together local patients who have benefited [from biomarker testing], providers who can talk about the importance [of biomarker testing and] also the barriers they face in getting standard of care tests approved by insurance, and other local groups that have a presence at the State house and can help move legislation (most often state medical societies), as well as state oncology societies, who are a really important partner in this work,” she said.

While legislative efforts to change policy and provide Medicaid coverage for biomarker testing is vital to improving equity, change cannot come soon enough for oncology providers.

The Provider Perspective

On the ground, the impact of biomarker testing can be measured in life expectancy. In a recent interview about the impact of biomarker testing and strategies to improve equity and access to precision medicine,  Luis E. Raez, MD, FACP, FCCP—chief scientific officer and medical director at Memorial Cancer Institute/Memorial Healthcare System in Pembroke Pines, Fla., and ACCC Precision Medicine Stewardship Advisory Committee member, said, “I have been treating patients with lung cancer for over 20 years, and the first 10 years were really sad…giving the same chemotherapy to everybody, the results were very poor. Most survived a year and less than 5% survived 5 years. That’s why we really need precision medicine and comprehensive biomarker testing. Nowadays, the [average] minimum survival is 8 years thanks to precision medicine. It’s the right thing to do for patients.” 

Dr. Raez argues that biomarker testing should be a patient’s right and access to it would be facilitated with national and state-level legislators on board. A simple biomarker test would also save millions in unnecessary spending on more expensive and less-effective treatments.

“If you are a patient with cancer, you should have the right to a genomic biomarker test and have that test covered. This would solve a lot of problems, but we are not there yet. This is why we must educate our politicians that this is something we need—we need this genetic information to do precision medicine…We cannot provide good cancer care if we do not use biomarker testing for every tumor. We need to invest in precision medicine,” Dr. Raez said.   

Taking Action

ACCC and its program partners the ACS CAN and LUNGevity, with support from Foundation Medicine and Exact Sciences—are committed to raising awareness among providers, patients, and health plans about the importance of increasing access to biomarker testing to facilitate comprehensive cancer care.

Insights and findings through the collective initiative, Improving Access to Biomarker Testing in Medicaid Populations, will inform the development of future programs and resources to help overcome current barriers and make the case for increasing access to comprehensive genomic profiling for Medicaid beneficiaries.

ACCC’s education program Improving Access to Biomarker Testing in Medicaid Populations is made possible by support from Foundation Medicine and Exact Sciences.