The NGS technologies and the Molecular Tumor Boards, indispensable today for precision medicine and to guarantee each patient the most suitable treatment for his case, are not implemented homogeneously on the national territory
These are the new frontiers for tumor management, yet Next generation sequencing (NGS) technologies, genomic profiling tests capable of analyzing the entire human genome, and the Molecular Tumor Boards (MTB), interdisciplinary teams of experts dedicated to interpreting clinic of the newly available data, they are not implemented homogeneously in Italy. A disparity that potentially jeopardizes equal opportunities for patients to access innovative therapies. The offer of services is in fact heterogeneous. In specialized centers for oncological therapies, next-generation NGS sequencing is used only in 50% of cases. The Molecular Tumor Boards are present patchily, in 13 Regions out of 19 and with a great variability of organizational models: seven are the regional ones surveyed, but there are also intra-regional corporate or network groups. Above all a third of professionals (33.6%) do not have access to the team. These are the main results that emerged from the national survey conducted by the Italian College of leading hospital medical oncologists (Cipomo) as part of the «Precision Oncology» project, published in the international journal The Oncologist
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Survey data
In total, they participated in the survey, conducted from 10 to 28 February 2022, 129 directors of medical oncology departments in 19 Italian regions (of which 2 autonomous provinces), representing over 98.5% of the Italian population and various institutions, including health authorities (45.1%), public hospitals (36.3%), public university hospitals (10, 6%), scientific research institutes (3.5%) and private professionals (0.9%). In companies using NGS sequencing, the laboratories are located in 81.4% of cases within the structure or in the regional network. Only 18.6% turn to private services. As regards the aspects related to reimbursement, most of the interviewees (57.7%) did not know if their Region had defined specific rates for this type of analysis. The Molecular Tumor Boards were present and formally decreed, at the time of the survey, in Piedmont, Liguria, Lombardy, FVG, Veneto, Emilia Romagna, Tuscany, Marche, Umbria, Lazio, Campania and Sicily. In Puglia it was present, but not yet formally decreed. 43.7% of professionals say they have never needed to refer cases to the group for counseling, and 32.4% believe the current organization of Molecular Tumor Boards in their setting does not meet their needs.
Agile multidisciplinary teams
Asking professionals what level is most appropriate for setting up a Molecular Tumor Board, it emerged that 38.6% would prefer a regional one, 43.6% believe that an intra-regional level is more functional and 17.8% consider that the coexistence of a local board for routine clinical activity and a regional one coordination may be the best solution. The survey also revealed a clear orientation in favor of an agile composition of the Molecular Tumor Boardswhich sees some key figures permanently present (oncologists, pathologists, molecular biologists, geneticists, pharmacists and case manager), in fewer numbers than the first regional boards established which included many more professional figures. All directors agreed with the presence of an oncologist and the majority deems essential the presence of: molecular biologists (96%), pathology (92%), geneticists (76%), hospital pharmacists (60%) e case manager (57%). “The results of this survey confirm the need for continuous joint work between professionals and government institutions on the rapidly evolving fronts of medical oncology,” he says. Gianpiero Fasola, director of the Department of integrated oncology and director of Oncology at the Santa Maria della Misericordia University Hospital Asu Friuli Centrale —. The dynamics of our discipline are very fast: if we don’t promptly adjust the organization, we run the risk of not bringing the benefits of innovation to all patients».
Informed consent
Another node is that of informed consent, managed differently in the various realities analysed. 53.5% of the oncologists interviewed report that consent is required for molecular analyses, 36.6% that it is not required as it is implicit in the diagnostic-therapeutic process and 9.9% that consent from patients is only required for NGS analysis. A heterogeneity that calls into question the need for clear guidelines from the Ministry of Health for the acquisition of patients’ consent in carrying out these surveys. «Based on this analysis – he declares Louis Cavanna, president of Cipomo — government institutions can draw useful ideas for refining the measures and applying them in various fields. One must take into account the essential elements necessary for make precision oncology accessible to all potential recipientsappropriately and sustainably. Among these: the population and the geographical extension, the organizational models, the experiences already in progress and the dynamics of rapid evolution of knowledge».
March 17, 2023 (change March 17, 2023 | 06:47)
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