Precision medicine: What employers need to know

Cancer. The very word strikes fear in the hearts of most people. While a cancer diagnosis is nowhere near the death sentence it used to be, the disease remains a terrifying prospect. Science has taught us the earlier cancer can be detected, the more promising the outcome, yet traditional cancer screenings like colonoscopy and mammography have their limitations – often due to the hesitancy of patients to undergo what are widely considered uncomfortable or invasive diagnostic procedures.

Another limitation of traditional medical tests and treatments is their one-size-fits-all design. Biology teaches us that no two people are exactly alike. Therefore, it is impossible to have a singular treatment that will produce the same result for everyone.

For decades, researchers have sought to improve the detection, prevention and treatment of cancer. Many of their working theories were built around the idea that the body’s immune system could play a pivotal role in eradicating the disease from the body – a hypothesis that led to the development of precision medicine, a promising approach in the detection and treatment of cancer.

Precision medicine is not a new concept. Nearly a decade ago, President Barack Obama announced the Precision Medicine Initiative to revolutionize how we improve health and research and treat disease. The initiative defined precision medicine as “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.” This empowers physicians to provide targeted, personalized treatment to each patient based on specific characteristics, such as their genetic makeup or the genetic profile of an individual tumor.

With cancer continuing to be the number one cost driver for employers, plan sponsors are understandably encouraged by the potential for precision medicine to vastly improve cancer diagnosis and treatment, resulting in better outcomes for participants and reduced costs for employers. However, the environment for precision medicine is rapidly evolving – and so must health care plans. What do employers need to know and how should they respond to ensure that employees have access to these newest innovations?

Testing guides treatment

At the heart of precision medicine are the tests that guide diagnosis and treatment. A biomarker is a protein on the cell surface or a genetic mutation that is used to identify the unique features of a particular cancer cell. Biomarker testing provides an objective measure of what’s going on within a cell at a given moment. By identifying changes in solid tumors and blood cancers, it gives physicians the ability to select treatments that improve outcomes with fewer adverse effects.

There are two types of biomarkers – prognostic and predictive. Prognostic biomarkers tell how aggressive a cancer is. A favorable prognostic marker indicates that a patient will do well no matter what type of therapy is administered, while an unfavorable biomarker signals a likely shorter survival. Meanwhile, predictive biomarkers enable doctors to use the protein from the cell surface or the genetic mutation to determine which treatments are most appropriate for that specific patient.

Certain types of mutations can cause a tumor to become super sensitive to a particular type of therapy or to make it resistant to that therapy. Biomarker testing guides doctors in choosing the treatment that’s most likely to produce a positive result for each individual patient. It can also predict if a cancer is likely to return, which may lead some patients to opt for more aggressive treatments, such as chemotherapy or radiation or, in the case of breast cancer patients, a mastectomy.

Awareness of precision medicine for cancer treatment is growing rapidly thanks to media and the internet. Consequently, patients are increasingly asking doctors for these innovations by name. That’s certainly been the case with Cologuard®, the heavily advertised at-home colon cancer screening test that detects microscopic blood and altered DNA within the stool. However, medical professionals are concerned about the risks of testing a broad swath of the population for cancer.

Risk and reward

While early detection is critically important when it comes to cancer diagnosis, there are risks and limitations associated with precision medicine. For example, what happens if a diagnostic tool detects cancer in a patient, but further testing finds no evidence of the disease?

Many precancerous cells cause mutation, but our immune system often eliminates these cells or they die on their own because they don’t have the right order of changes to turn into cancer. Therefore, you could detect something that’s not ever going to turn into cancer – or you might detect a cancer that is currently dormant and may not cause any problems for 15 or 20 years. Because the test came up positive for cancer, however, you have a stressed-out patient worried there is a ticking time bomb hidden somewhere in their body.

This risk can be partially mitigated by pairing genetic counseling with genetic testing to assist with test interpretation and appropriate next steps. It’s also important to ensure these tests are used in the proper manner – that is, targeted to those at increased risk of cancer, rather than the general population. For employers looking to incorporate these tests into their benefits design, that means using risk profiles to determine who should receive them. And while there are some tests that screen for more than 50 types of cancer with a single drop of blood, many doctors favor personalized, individualized testing based on a patient’s family history, as opposed to multi-cancer early detection. Studies on many of the multi-cancer tests are currently ongoing, so time will tell, but such tests run the risk of causing patients unnecessary stress without any measurable benefit in terms of a longer survival rate, for example.

Hope for the future

Clearly, science has some catching up to do to support the role of precision medicine. Thus, it’s incumbent upon employers to educate employees about the risks of diving into new medical technology without fully understanding potential negative consequences. They must walk a fine line, painting a clear picture of current limitations, while sharing hope for what the future of precision medicine holds.

There are a number of actions benefits leaders can take to continue supporting cancer prevention and early detection and preparing the workforce for the precision medicine revolution:

* Helping employees get access to trusted resources with the latest information on precision medicine as it relates to their health history and risk profile, in advance of full adoption, thus mitigating some of the risks

* Monitoring the rapidly evolving genetic testing landscape as it relates to cancer and engaging with their health plan partners to ensure that coverage policies adhere to clinical guidelines

* Implementing routine claims reporting to identify areas of opportunity for better utilization management for genetic testing and identify areas of potential abuse/waste

* Exploring and partnering with a well-equipped cancer Center of Excellence (COE) to administer and monitor gene therapy or immunotherapy treatment

Related: Health care navigation’s vital role in cancer care

* Focusing on implementing solutions that enhance health care literacy in the workplace. Even if the company ultimately decides not to adopt a global policy on precision medicine for prevention, participants will eventually face these options with their primary care doctors or specialists

* Continuing to double-down on the actions employees can take to prevent cancer and boost health — tobacco cessation, regular exercise, proper sun protection, alcohol reduction and getting recommended screenings based on age and risk

Additionally, employers should invest time in understanding how precision medicine is addressed in their health plan and benefits strategy today. At least a quarter of employers surveyed by the Business Group on Health didn’t know what tests were actually covered, presenting an opportunity to be at the forefront in promoting quality and more personalized care as innovations occur.

Precision medicine has tremendous potential to revolutionize cancer outcomes by tailoring treatment based on individual variability in genes, environment and lifestyle. Unfortunately, plans haven’t caught up yet, so it becomes a dilemma for employers whose people are counting on their plans to be current on immune or targeted therapy coverage. As a practicing physician, I want patients to get the best care possible. At this pivotal moment, therefore, I urge employers to take those first crucial steps as they move forward with precision medicine for cancer as part of their benefits design – and to recognize the role they have to play in helping their people find high-quality, cost-saving care that enables the best possible outcomes in their battle against this frightening, but increasingly treatable disease.

Bipin Mistry, MD is Chief Medical Officer at Alight Solutions.