Article

Challenges in access to precision oncology treatment


We are witnessing a paradigm shift in the way cancer is treated. Drug development is focused on defining and treating cancer based on the genetic makeup of cancer cells rather than the tissue of origin. It has the potential for fewer side effects and more effective treatment for patients. With such disruptions taking place in the scientific and healthcare arena, major system changes are necessary so that cancer patients have access to these innovative treatment options.
 

 
Innovative precision oncology treatments add substantial value
 
The advantages for healthcare systems and society start at the time of diagnosis, and carry through to treatment. The first step in this process is genomic testing which can provide information about the tumor genome. Based on this, healthcare professionals can more accurately distinguish between patients who are likely to benefit from a medicine and those who will receive no benefit.
 
Patient benefit
Through precision oncology, doctors can more accurately predict which patients will benefit from certain treatments.  This means that patients are more likely to receive a medicine that delivers a clinical effect, a better outcome, and a reduced risk of side effects.
 
Healthcare system benefit
Precision medicine increases efficiencies in the healthcare system by reducing the use of therapies for patients for whom the treatment is not effective, leading to more efficient allocation of increasingly scarce healthcare resources.
 

The paradox: innovative treatments have the greatest barriers
 
The European Commission has officially stated that precision medicines offer a higher probability of desired outcomes for patients thanks to better-targeted therapies and earlier disease intervention. However, the paradox is that the most innovative cancer treatments experience the greatest barriers as they often target newly-discovered causes of cancer and cut across the traditional treatment approach. Unfortunately, in many countries, cancer treatments that take this new approach are not considered a priority when it comes to rethinking health policy.
 

Reimbursement for precision treatments could improve access
 
Countries should adapt their regulatory and reimbursement systems to prioritize precision oncology treatments and ensure that patients have access to these medicines and the necessary diagnostics. Any assessment of value should not be based on budgetary or arbitrary decisions.
There should be greater flexibility when assessing value frameworks. Supporting evidence here should include in-depth evaluations of patient outcomes, real-world evidence, and patient-reported outcomes. Additionally, interim or early access programs can allow for innovative medicines to be administered while additional value assessment and pricing negotiations are still being conducted.
 

Genomic testing to facilitate precision treatment as routine
 
There are still some access barriers, delays, and disparities for patients around the world that impede the use of precision oncology treatments for clinically eligible patients. This can result in a substantial loss of life years. This is mainly due to a lack of investment by countries into the infrastructure needed to support and take advantage of genomic testing.  Even in countries where the infrastructure does exist, there needs to be adequate funding for diagnostics in order for eligible patients to be tested.
 
However, even if countries invest in advanced testing infrastructure, there are other important components that facilitate access to precision medicine.  For example, France and the UK make significant investments in the testing environment but access to innovative precision treatments needs to move at the same pace.
 
Based on the considerable volume of clinical evidence that supports the value of precision medicine, it is vital that high-quality and broad genomic testing becomes part of routine clinical practice. Such measures could be supported by better reimbursement of testing, including genomic testing in clinical guidelines, and by increasing the number of labs with the capacity and capability to carry out such tests.
 

Making the value of precision oncology accessible
 
The promise of precision oncology presents an evolution in the way cancer is treated, delivering improved treatment for patients alongside greater efficiencies in healthcare systems. Tackling delays in reimbursement and creating a robust infrastructure to accommodate both testing and subsequent precision oncology treatments will now be fundamental in securing access for patients.
 
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