Originally published May 13.
NEW YORK (GenomeWeb) – North Shore Hematology Oncology Associates has enlisted the genomic profiling services of Caris Life Sciences to enable it to provide a personalized cancer care program in Long Island, New York.
The decision to provide testing services through Caris comes as NSHOA prepares to open its eighth office in Long Island this summer. In a statement, NSHOA touted this as "the area's first cancer center dedicated to personalized medicine." NSHOA treats 12,000 cancer patients each month across its offices, all of whom will have access to molecular profiling services through Caris.
"We were inspired to help our patients with the toughest, most aggressive cancers to have the best possible chance to battle those diseases close to home," NSHOA CEO Jeffrey Vacirca told PGx Reporter. "By analyzing their tumors to personalize their treatment, we are bringing the highest quality resources to bear."
Under the arrangement with Caris, the 18 NSHOA oncologists will be able to sign on to a secure portal that will lay out the available testing options – ranging from traditional pathology technologies using immunohistochemistry and fluorescence in situ hybridization, to more advanced diagnostics applying next-generation sequencing. The tests are internally developed by Caris and are intended to guide treatment decisions with up to 51 oncology drugs.
In the coming days, Caris hopes to link its test portal to NSHOA's electronic medical records, so doctors can make decisions about whether to test a particular patient for a molecular marker or a panel of markers, and determine if there are any suitable clinical trials for the patient.
NSHOA oncologists will use Caris' services to molecularly profile all patients with metastatic disease and uncommon or aggressive cancers – groups that fall outside the standard of care guidelines. "NSHOA came to us and said this is where they have a clinical need, where they need additional guidance," Phil Perez, senior VP of sales and marketing at Caris, told PGx Reporter.
Sandeep Reddy, Caris' senior medical director, further explained that sometimes the test "most appropriate" for a patient will be dictated by the amount of tissue available for analysis. This is not an uncommon challenge for doctors when molecularly profiling cancer patients. For lung cancers patients, for example, tissue samples are hard to procure and if only a small sample is available, testing for a panel of markers, rather than just a point mutation, might make the most sense.
Caris can provide NSHOA guidance in this regard. "There is always going to be a dialogue between the ordering physician and our people," Reddy said. "So, if at any time we find we're not going to be able to run every test [ordered], we're going to reach out to that physician … and try to figure out the most appropriate [test] combination for that patient."
This is the first deal with a community physician practice that Caris has announced. Caris has similar arrangements with other physicians groups but these haven't been publicized, according Perez.
More than 80 percent of cancer care in the US is delivered in community practices, and yet to date, precision medicine strategies have been the province of large cancer centers or academia. The New York metropolitan area is home to some of the most prestigious cancer centers and medical universities in the country, and many of them tout their own personalized oncology programs.
As such, NSHOA's decision to provide molecularly guided oncology care through Caris and publicize it to the community it serves was likely a competitive one. "The practice was really wanting to establish themselves as a differentiator in their area," said Perez, who spearheaded the deal between NSHOA and Caris. "They are in a highly competitive area with Memorial Sloan-Kettering, New York University, and Mount Sinai Hospital all in their back yard."
In Caris' interactions with customers, Perez and Reddy are increasingly encountering community healthcare practices that understand that providing molecular testing and precision testing strategies can give them an edge. "We're seeing that community oncologists, by partnering with services such as ours, are able to provide the same quality of care" as a large cancer center, Perez said. "This is where we're seeing a lot of traction in the community [setting]."
Interest for pharmacogenomic testing is growing among community healthcare practitioners in settings beyond oncology. For example, the University of Florida is using its own experience implementing PGx testing for cardiac patients to help set up similar programs at two cardiology practices at Orlando Health, a private healthcare network serving 2 million residents in central Florida and thousands of international visitors.
CompanionDx Reference Lab and information technology services provider Enable Healthcare partnered earlier this month to provide physicians in Enable's network access to CompanionDx's pharmacogenomics testing. And earlier this year, Avera Health, a network of hospitals, clinics, and nursing homes serving South Dakota and surrounding regions, launched a pilot project to use pharmacogenetic testing to personalize pain medications in orthopedic patients.
Caris also houses a registry through which NSHOA doctors will be able to track how molecular testing is impacting the practices' costs, its physicians' decision making, and most importantly, patients' outcomes. In the Affordable Care Act environment, physicians' practices are under pressure to show they are improving patients' health in a cost-effective manner. Personalized medicine proponents maintain that molecular profiling, if implemented in a rational fashion, can achieve these ends.
Meanwhile, managing test reimbursement has been one of the biggest barriers to adopting personalized medicine strategies for community practices. In this regard, Caris also handles diagnostics billing for NSHOA. "That's not going to be an onus to North Shore or their patients," he said, noting that doctors offices are more used to billing for physicians' services or drugs, not diagnostics.
"What I've experienced talking to physicians around the country is that [test reimbursement] becomes another layer of complexity that they don't want to deal with," Reddy observed. "[Molecular profiling] is a more of a pathology service … so the oncologists don't want to deal with it," he said. "So, they shove it off to the hospital, but then, the hospital says, 'Well, we don't want to deal with this.' … So, it just gets lost in the shuffle and these patients aren't being [molecularly] profiled."