Implementation of an academic precision oncology service in a community setting.

Abstract

1531 Background: Implementation of precision oncology (PO) in community practice remains challenging due to insufficient resources to order and interpret genomic test results. In 2023, our PO program (located at an academic hub) partnered with a community site to optimize clinical workflows around molecular testing and to provide documented expert review of testing results. To date, the service has reviewed over 150 cases. We undertook a retrospective review to determine the impact of our intervention on the rates of next generation sequencing (NGS) ordered at this site. Methods: Patients with visits to the community cancer center between 1/2022 and 7/2024 were screened for inclusion (n = 900). Eligible patients had an advanced/metastatic solid tumor and were managed at the community site. Patients were placed in the historical or interventional cohort based on the date that their cancer became advanced/metastatic relative to the service implementation (1/1/2023). Due to a historical lack of genomic data integration within the EHR, evaluation of NGS results and subsequent treatment required manual chart review. The study was approved by the IRB of the University of North Carolina. Results: We identified 109 historical patients and 76 interventional patients who met eligibility. NSCLC patients comprised the majority of the population (27%), followed by prostate (12%), breast (10%), and colon (7%) cancers. We observed a significantly increased rate of NGS testing in solid tumors after implementation of the service (40.4% versus 57.9% before and after, p = 0.0192). The rate of NGS testing within 30 days of diagnosis of advanced/metastatic disease also improved in the interventional cohort (21.1% versus 36.8%, p = 0.0187). The median time from first clinic visit to results was 20.5 days in those who were testing in the historical cohort versus 10.5 days in the interventional cohort. RNA transcriptome sequencing was used more frequently in the interventional cohort (40.9% versus 6.8%, p = 0.0003). Conclusions: Utilization of a PO program at an academic hub to support NGS testing at a community site resulted in increased testing rates and more timely access to results in advanced cancer patients. Although limited by sample size, the data emphasizes a continued need for infrastructure to support the application of PO in community settings. Historical (Prior to 1/1/2023) Interventional (After 1/1/2023) P-value Rate of NGS testing in all patients 44/109 (40.4%) 44/76 (57.9%) 0.0192 Rate of NGS testing within 30 days of diagnosis 23/109 (21.1%) 28/76 (36.8%) 0.0187 Rate of NGS testing in NSCLC 15/24 (62.5%) 22/26 (84.6%) 0.109 Rate of blood-only NGS testing in those with results 27/44 (61.4%) 19/44 (43.2%) 0.0896 Rate of genome-informed therapy (all patients) 5/109 (4.6%) 8/76 (10.5%) 0.121 Rate of genome-informed therapy (NSCLC) 1/24 (4.2%) 4/26 (15.4%) 0.3508 Median time from clinic visit to NGS testing results 20.5 days 10.5 days -----