Landscape of cancer biomarker testing in England following genomic services reconfiguration: insights from a nationwide pathologist survey

Phillipe Taniere; Andrew G Nicholson; John R Gosney; Maria Angeles Montero Fernandez; Danielle Bury; David Allan Moore; Eldo Verghese; Irshad Soomro; Leena Joseph; Nidhi Bhatt; Patrizia Viola; Rozinder Bains; Adrienne G Lanctot; Jacqueline Ryan

doi:10.1136/jcp-2023-208890

Landscape of cancer biomarker testing in England following genomic services reconfiguration: insights from a nationwide pathologist survey

J Clin Pathol. 2023 May 31:jcp-2023-208890. doi: 10.1136/jcp-2023-208890. Online ahead of print.

Authors

Affiliations

¹ Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK phillipe.taniere@uhb.nhs.uk.
² Respiratory Pathology, National Heart and Lung Institute, Imperial College London, London, UK.
³ Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK.
⁵ Histopathology, Manchester University NHS Foundation Trust, Manchester, UK.
⁶ Histopathology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
⁷ Cellular Pathology, University College London Cancer Institute, London, UK.
⁸ Histopathology, St James's University Hospital, Leeds, UK.
⁹ Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁰ Cellular Pathology, North Bristol NHS Trust, Westbury on Trym, UK.
¹¹ Cellular Pathology, Imperial College Healthcare NHS Trust, London, UK.
¹² Novartis Pharmaceuticals UK Ltd, London, UK.

PMID: 37258251
DOI: 10.1136/jcp-2023-208890

Abstract

Aims: Cancer diagnostics have been evolving rapidly. In England, the new National Health Service Genomic Medicine Service (GMS) provides centralised access to genomic testing via seven regional Genomic Laboratory Hubs. The PATHways survey aimed to capture pathologists' experience with current diagnostic pathways and opportunities for optimisation to ensure equitable and timely access to biomarker testing.

Methods: A nationwide survey was conducted with consultant pathologists from regional laboratories, via direct interviews based on a structured questionnaire. Descriptive analysis of responses was undertaken using quantitative and qualitative methods.

Results: Fifteen regional centres completed the survey covering a median population size of 2.5 (1.9-3.6) million (each for n=12). The median estimated turnaround time (calendar days) for standard molecular markers in melanoma, breast and lung cancers ranged from 2 to 3 days by immunohistochemistry (excluding NTRKfus in breast and lung cancers, and PD-L1 in melanoma) and 6-15 days by real-time-PCR (excluding KIT for melanoma), to 17.5-24.5 days by next-generation sequencing (excluding PIK3CA for breast cancer). Tests were mainly initiated by pathologists and oncologists. All respondents discussed the results at multidisciplinary team (MDT) meetings. The GMS roll-out was perceived to have high impact on services by 53% of respondents, citing logistical and technical issues. Enhanced education on new pathways, tissue requirements, report interpretation, providing patient information and best practice sharing was suggested for pathologists and other MDT members.

Conclusion: Our survey highlighted the role of regional pathology within the evolving diagnostic landscape in England. Notable recommendations included improved communication and education, active stakeholder engagement, and tackling informatics barriers.

Keywords: CANCER; DIAGNOSTICS; Health Services.