Genomic testing, equitable access in cancer patients

Iciar Martinez and Joaquin Mateo.

The precision medicine has allowed in recent years to develop all kinds of treatments aimed at cancer-specific molecular targets. Despite this great advance, the reality is very different from daily clinical practice where many treatments, despite being approved, cannot be applied, creating a significant barrier in access to precision drugs. To modify this situation, a group of Spanish professionals from different health specialties, together with other European experts, have prepared a study published in the journal Naturein which they have offered their vision on the matter so that the precision medicine can reach all patients.

To achieve a more equal and equitable access at genomic tests, joaquin matthewmain author of the work, head of the Translational Research Group on Prostate Cancer at the Vall d’Hebron Institute of Oncology (VHIO) and oncologist at the Vall d’Hebron University Hospital in Barcelona, ​​explains to Medical Writingto the four pillars fundamental to achieve it: “Generate patient-centered access networks, improve the way in which the value of the test is measured and decide which tests are valid to incorporate them into the sanitary systempromote the education of health professionals to be able to use these tests in the most optimal way possible and, finally, weight and inform patients so that they take the initiative regarding their data and health, that is, help them in making decisions shared in the field precision medicine“.

For its part, Iciar Martinezhospital pharmacist and coordinator of the Genetics-Genomics Unit of the Balearic Islands (Genib) and the Molecular Diagnosis and Clinical Genetics Unit of the Hospital Universitari Son Espases (HUSE), who has also participated in the work, adds that “the equal access by patients at genomic tests it can be achieved, first, by making politicians aware of what genomic tests mean, since they are not aware of the different types of techniques that exist. And, second, by working on topological ‘maps’ of health and disease that include, for example, the microbiomes. These maps will be the future and it is where we have to work, “he points out to this medium.

Financing of organisms and access of regulatory entities

As for the drug funding agencies and the regulatory entities that allow real access to the patient, Mateo asserts that “the problem that is identified in Spain is that the clinical practice guidelines do not include the same evaluation criteria as the regulatory entities. An aspect that leads to the provision of some guides with a drug recommendations that in reality they do not exceed them because the agencies have taken into account other variables. Therefore, it is important that all the different parties that make these decisions go together, as it confuses the patient and the professionals, which generates some frustration.”

Iciar Martínez: “Health must define the genomic portfolio to see which diagnostic tests must be included in all hospitals”

An inconvenience that the hospital pharmacist Martínez also shares and to which, in addition, another is added: “Health must define the genomic portfoliothat is diagnostic tests must be included at a minimum in all hospitals in Spain to create equitable access to these tests that, after all, end up being, in the case of Pharmacogenomics and in cancer treatment, only route of access to a specific drug“.

For this reason, Martínez clarifies that “there is the paradox that, on many occasions, an approved drug is available in the basic portfolio of pharmaceutical services, but the diagnostic test required by the health professional to be able to administer said drug is not included in the National system of health (SNS), which is nonsense”. Likewise, the specialist determines that “we must work together with health authorities so that access to drugs in the SNS is equal to that of the genomic testing portfolio“.

Improve the flow of data information between hospitals

The flow of information between hospitals It is also a pending issue for Spain, according to the two experts. To solve this problem, according to Mateo, “three main axes must be addressed: the economic axis of investments, the education of health professionals so that they interpret the tests and obtain the maximum information from the patient and, thirdly, improve the systems so that patient data can be evaluated by specialists that may be in different places, since the patient is the center of the data process in precision medicine“.

Joaquín Mateo: “Patient data should be able to travel between the different hospitals in an easy and safe way”

In this sense, Mateo stresses that “there must be a infrastructure that facilitates testing to a patient in the laboratory and these data can travel in an easy way so that the specialist, located anywhere in the world, can interpret them in the best possible way for the patient, since to date, the patient’s data is concentrated in a hospital and it is very difficult to get out of there. Therefore, the data would have to be able to travel between the different hospital centers in an easy and safe way“.

For Martínez, “we should bet on create circuits or clinical units in which specialists from Oncology, pathology units and Molecular Biology participate and work together so that they can handle this information and help other colleagues who are in other smaller hospitals and do not have enough reach and facilitate diagnosis and treatment more equitable for the patient at that time,” he concludes.

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