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Genomic Testing Associated with Significantly Lower Health Care Costs in High-Risk Breast Cancer Patients, According to Researchers from Duke University

PLYMOUTH MEETING, Pa., March 19, 2019 /PRNewswire/ -- New research from Duke University, published in the March 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network, provides evidence that genomic recurrence score (RS) testing using the 21-gene assay is associated with decreased cancer care costs in real-world practice among certain patients with breast cancer who would otherwise receive standard chemotherapy. The RS test helps to predict whether or not an individual woman with non-metastatic breast cancer is likely to benefit from adjuvant chemotherapy. According to these findings, patients identified as clinically high-risk who underwent RS assessment had costs that were roughly $6,600 lower than those who went untested, $3,600 of which was attributable to lower direct chemotherapy costs.

The researchers also found that while RS testing was associated with higher overall costs for patients in the clinically intermediate- and low-risk categories, there were no differences in average chemotherapy costs for these subsets. The increased costs were almost entirely due to higher non-cancer costs.

"This study demonstrates that RS testing provides the greatest reduction in costs among patients who, prior to the test, had the highest likelihood of receiving chemotherapy to begin with," said Michaela A. Dinan, PhD, Duke University. "In the big picture, the ability for RS testing to reduce either the cost of chemotherapy or total health costs may depend on the general distribution of patients who are clinically considered to be high-, intermediate-, or low-risk. This knowledge should help inform a provider's decision about when RS testing may be most likely to influence treatment choices."

Dr. Dinan continued, "Our research indicates that selective use of RS testing, particularly for people with clinically-determined high-risk, non-metastatic breast cancer, provides treatment benefit and cost savings."

The study was conducted on data from 30,058 Medicare beneficiaries aged 66–75, diagnosed with ER-positive, non-metastatic, invasive breast cancer between 2005 and 2011. 17.5% overall received RS testing as part of their initial workup; within that group, 13.3% were initially clinically classified as low-risk, 69.5% as intermediate-risk, and 17.2% as high-risk. The data came from a Surveillance, Epidemiology, and End Results (SEER) and Medicare linked data set, and costs were calculated by summing Medicare payments from all patient claims and adjusting them to 2013 U.S. dollars.

The team had previously conducted research showing that the RS test leads to a reduction in chemotherapy in women with high-risk disease—suggesting that the test has helped women to opt out of chemotherapy in circumstances where they would have otherwise received it without benefit.

"The NCCN Guidelines recommend strong consideration for the 21-gene assay in patients with ER+, node-negative, pT1b–pT3 tumors, in order to help decide whether or not to add chemotherapy prior to endocrine therapy," commented Ingrid A. Mayer, MD, MSCI, of Vanderbilt-Ingram Cancer Center, and Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Breast Cancer. "Despite several limitations and confounding biases for this currently published study, its results are consistent with other studies in the U.S. and around the world. However, the clinical high-risk group—which is most affected by RS testing in this study—represents a minority of patients in that age group. Therefore, it is likely that the larger financial impact of RS would be seen in a younger patient population; which is more likely to present with clinically higher-risk cancers. Ultimately, reducing chemotherapy for that group would not only reduce overall treatment costs, but also spare these patients from being absent from the work force, which could have a huge impact on individual household finances."

The study's authors also noted that because of the older population in this study, chemotherapy rates were significantly lower than previously reported rates. They agreed that RS testing would likely result in an even more dramatic reduction in costs among younger, higher-risk patient populations with higher baseline rates of chemotherapy use.

Complimentary access to the full study, "Chemotherapy Costs and 21-Gene Recurrence Score Genomic Testing Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005 to 2011" is available until June 10, 2019.

The entire March issue can be found on the redesigned website, which features simplified site navigation and a better viewing experience across all devices. This edition also includes a guest editorial from NCCN's Chief Medical Officer, Wui-Jin Koh, MD, on NCCN's efforts to increase the accessibility of the NCCN Guidelines and other big plans for the future.

About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit To inquire if you are eligible for a FREE subscription to JNCCN, visit Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.

The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

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