In the community-based setting, where 80% to 85% of patients with cancer receive care, the choices may seem overwhelming. Before choosing a platform, test or vendor, the following factors may be considered (Figure 3):
Figure 3. Areas of consideration for choosing genomic testing assay.
Health status of patient
- Invasive procedures are used to obtain biopsy material for genomic testing; therefore, the patient must be in sufficient health status to undergo such procedures.
- Planning for multiple lines of therapy may be expected for a patient in relatively good health status, whereas only a single line of therapy is to be expected for a patient who is rapidly progressing, both of which may impact the type of assay pursued.
- Is the biopsy a large surgical specimen, or small cytology sample?
- Specimen requirements vary widely by test; therefore, it is imperative to review these specifications to increase chance of successful testing.
Cost, insurance coverage and/or financial status
- A patient with cancer endures an increasing financial burden associated with his or her care; therefore, cost of the assay, which may be dependent on the depth of testing (single tests vs. multigene assays), should be evaluated.
- A portion of the costs associated with commercial assays are likely to be covered by most insurance carriers, but patients may incur out-of-pocket expenses.
- If genomic testing is required to guide selection of targeted therapies considered standard of care, then single tests such as companion diagnostics or targeted sequencing panels may be practical choices.
- If genomic testing is pursued to identify clinical trial options, then casting a wider net of genomic data may be preferred to maximize information output.
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