- Precision medicine is quickly moving out of the realm of science fiction and into the everyday routines of oncologists, neurologists, and other providers treating patients who may have had little hope just a few short years ago.
While the cures for cancer, Alzheimer’s disease, genetic disorders, and diabetes are as of yet undiscovered, researchers and clinicians are getting closer to being able to target the most effective therapies to individuals based on the unique makeup of their genes.
This approach is generating significant excitement among healthcare providers, including oncologists. In a recent survey by Cardinal Health, released in conjunction with the 2018 ASCO Annual Meeting in Chicago, more than a third of oncologists said that precision medicine will have a “significant impact” on cancer care within just two or three years.
Two thirds of cancer doctors are already using genomic testing to inform their treatment decisions, the poll added, and another 25 percent are planning to integrate genomics into their care routines within the coming year.
Costs for genetic testing have dropped precipitously since the early 2000s, allowing a few large organizations, like Geisinger Health System, to offer inexpensive DNA sequencing more routinely for patients.
Geisinger recently announced that genetic testing will soon be available to all of its patients, even if they are not seeking treatment for a specialized disease.
“Sequencing the known functional parts of the genome for our patients is becoming a clinical reality, not just as a diagnostic test for patients who present with particular symptoms, but for all patients in the communities we serve,” said David Ledbetter, PhD, Executive Vice President and Chief Scientific Officer.
While these offerings seem promising for patients at Geisinger, smaller organizations and those that have not invested quite as heavily in precision medicine to date may have a more difficult time bringing genomics into everyday care, the Cardinal Health survey cautions.
Fifty-eight percent of oncologists said they do not have access to genetic testing at their organization, while 36 percent must wait two weeks – or longer – for the results.
Expanding the availability of affordable, timely genetic testing will be a key component of integrating precision strategies into care for common conditions.
One supermarket chain is taking on that challenge. Clinical-grade genetic testing will be available directly to patients at a select group of pharmacies, thanks to a new partnership between Albertsons Companies and genetic testing company Genomind.
Pharmacy patients at a handful of supermarket chain locations in Boise, Philadelphia, and Chicago will be offered free education about a test that may help identify an effective therapy for some mental health concerns.
Up to half of patients respond poorly to the first medication they try for common mental health issues such as anxiety, depression, and obsessive-compulsive disorder, according to a press release.
Using genetic testing to identify which drugs have a higher likelihood of success could prevent patients from experiencing negative side effects or no impact at all from certain medications.
If the patient decides to take advantage of the testing option, or a pharmacist recommends the test based on patterns of ineffective trials of drugs in the past, the pharmacist can contact the patient’s care provider and suggest the test. The patient can then complete a cheek swab at the pharmacy.
The test covers more than 20 drug classes, 122 FDA-approved medications, and 97 percent of medications used to treat issues such as depression, anxiety, bipolar disorder, schizophrenia, ADD, and autism.
"We are excited to bring this opportunity to educate our patients about how genetic testing may be able to help them get better faster as they face mental health challenges," says Mark Panzer, Albertsons Companies Senior Vice President of Pharmacy, Health & Wellness.
Previous research from Genomind, published in the journal Depression and Anxiety, shows that mental health patients who receive genetic testing to guide treatment for mood and anxiety disorders experienced 40 percent fewer ED visits and 58 percent fewer hospitalizations than those whose clinicians did not have access to genomic information.
The study also estimated that 6-month costs for patients who received testing were close to $2000 lower than those without a test.
Patients are generally eager to take advantage of these new testing opportunities, recent consumer surveys have shown.
In addition to the growing popularity of at-home genetic testing kits that can identify some clinically-relevant aspects of a person’s heredity, patients are willing to pay moderate sums for access to a full-scale genetic breakdown.
In late 2017, a poll by Wamberg Genomic Advisors found that 75 percent of consumers believe genetic testing could improve their health or lead to a longer life.
Sixty-five percent would take advantage of genetic testing if it was easily and affordably available from their employers, with more than half willing to pay up to $250 for the benefit.
Relatively few respondents to an accompanying Wamberg survey were distressed by what their genetic tests revealed.
Only 16 percent said they were confused by the results, and just 6 percent experienced anxiety or depression after learning about their risks for certain hereditary conditions.
The results indicate that consumers may be ready to embrace the efforts by healthcare organizations, employers, and other groups to expand the availability of genetic testing and personalized approaches to care.
As interest grows, testing becomes more common, and costs continue to fall, healthcare providers may find themselves with access to very precise data that could make treatment decisions more personal and more effective.
While this influx of data may present a new set of challenges to providers who may not yet be sufficiently comfortable with interpreting and applying genetic test results to care, patients are likely to benefit in the long term from the growing potential to deliver deeply personalized care for a variety of hard-to-treat conditions.