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A recent study published in JAMA Network Open found that most older adults with cancer are not receiving genomic testing, which can help their care team choose treatment. The study reviewed Medicare records for 391,151 patients age 66 and older who were diagnosed with lung, breast, colorectal, prostate, or endometrial cancer between 2016 and 2023.

Across those eight years, 91.4% of patients did not receive genomic testing. However, testing did become more common over time, with 6% of patients tested in 2016 and 16.7% tested by 2023.

What is Genomic Testing?

Genomic testing looks for changes in the genes of a tumor or for gene changes a person inherited. These changes can tell a doctor whether a targeted treatment is likely to work. More and more cancer treatments approved by the Food and Drug Administration (FDA) are only prescribed when a specific gene change or biomarker is present.

Without testing, a doctor may not know that one of those treatments is an option. Not everyone needs genomic testing, and the study could not tell which patients were candidates for it. But the researchers noted that testing remained far from universal, and that how often it was used varied widely from one cancer type to another.

Next-Generation Sequencing

Next-generation sequencing, or NGS, checks many genes at once from a single tumor sample. Older tests usually look for just one or a few gene changes, so NGS gives a fuller picture of what is driving a tumor. Most patients in the study who were tested did not receive NGS, and instead received older, more limited tests.

NGS alone accounted for less than 1% of patients through 2020, rising to 2.1% by 2023. Medicare began covering tumor NGS nationally in March 2018 and inherited, or germline, testing in January 2020. Before then, coverage decisions were made regionally, so what a patient could get depended in part on where they lived.

The study’s findings highlight the need for increased access to genomic testing, particularly for older adults with cancer. As cancer treatments become more targeted and personalized, genomic testing will play a critical role in ensuring that patients receive the most effective treatment for their specific type of cancer.

Lung cancer had the highest testing rate for most of the study, rising from 12.8% in 2016 to 21.4% in 2021. It also had the highest NGS use, reaching 9.2% by 2023. Breast cancer had the highest overall testing rate by 2023, at 28.6%, while prostate cancer had the lowest testing rates, between 2.8% and 5.1%.

The researchers noted that differences in treatment options and guidelines likely explain much of the gap in testing rates between different types of cancer. Lung cancer has several gene changes that can be matched to targeted drugs, and national guidelines recommend full tumor NGS for patients with non-small cell lung cancer.

Barriers to Testing

Cost and coverage may also play a role in the low testing rates. The researchers pointed to earlier research finding that nearly one-fourth of cancer-related NGS claims in Medicare were denied. Geographic gaps in testing were also identified, with most testing happening among patients in metropolitan areas.

Age was also a factor, with earlier research finding that younger patients with cancer are more likely to be tested and more likely to have a gene change that can be treated with a targeted drug. The lower rates among older adults may represent a disparity, the researchers said.

Race and ethnicity did not appear to be a factor in testing rates, although earlier studies had found lower rates of inherited genetic testing in some groups. The researchers noted that Medicare coverage, income, access to care, geography, and the limits of billing data could all have shaped what they saw.

Related: Sorry, You Have Been Blocked

Patients who have recently been diagnosed with cancer may want to ask their care team whether genomic or biomarker testing is recommended for their cancer type, and how the results could affect treatment choices. The researchers focused on tests done within six months of diagnosis, because that is when results are most likely to guide treatment.

The study was done by reviewing Medicare billing records from Jan. 1, 2016, through Dec. 31, 2023, drawn from a 20% nationally representative sample of patients enrolled in Medicare Parts A and B. Half of the patients were female, and 31.8% were older than 75. Patients who died within 30 days of diagnosis were not included.

The study had several limitations, including the fact that Medicare billing records do not include details such as cancer stage, biomarker status, or test results. The findings also reflect traditional Medicare and may not apply to patients with Medicare Advantage or commercial insurance.

More work is needed to understand the value of expanding NGS and to address the barriers keeping patients from testing, the researchers said. The study’s findings highlight the need for increased access to genomic testing and the importance of continued research in this area.

Cancer care teams face significant challenges when handling the complex setting of treatment options, often struggling to keep up with rapid advancements in medical science. This struggle mirrors the difficulties faced by other medical specialists, such as those dealing with acute myeloid leukemia care, where patient outcomes are heavily dependent on timely and accurate diagnosis and intervention. The frustration of being blocked from accessing necessary platforms or information can further complicate these efforts, leaving both patients and providers feeling helpless. Such barriers can create a sense of isolation that extends beyond the clinical setting, affecting the entire support system surrounding a patient’s recovery. In some cases, the situation becomes so severe that a user blocked by a social media platform may find their only avenue for support severed, leaving them with nowhere else to turn. This highlights the critical need for robust, accessible communication channels that can bridge the gap between patients and their care teams. Furthermore, the emotional toll of a diagnosis can be overwhelming, leading many to seek solace in community support groups. However, finding a space where one feels truly heard and understood is not always easy, as evidenced by the common experience of seeing the message “Sorry, you have been blocked” when attempting to connect with others online. This digital exclusion can exacerbate the emotional strain of a cancer diagnosis, making it even more important for healthcare providers to offer full support that addresses both the medical and emotional needs of their patients.