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News — Precision medicine has revolutionized cancer treatment. By utilizing drugs that target the specific genetic defects in a patient’s tumor or by looking at the genetics of their cancer to determine which therapies will work best, this individualized approach can offer patients the most effective treatment with the fewest side effects.

But that’s true only for patients who have access to these treatments. Nearly 2 million people in the United States are diagnosed each year with cancer and there is a growing number of FDA-approved drugs designed to treat cancers that carry specific genomic alterations, but access to these targeted treatments varies widely and only about half of people eligible receive them, said Shellie Ellis, Ph.D., associate professor of population health at the University of Kansas Medical Center.

“You can have a drug that is 100% effective for anybody who takes it,” noted Ellis. “But it’s 0% effective if it never reaches the population for whom it's intended.”

Rural cancer patients, who are more likely to die from their disease than non-rural patients, have an especially hard time accessing targeted treatments. They tend to live far from institutions that have the expertise and resources to provide this level of care. Many rural patients lack sufficient insurance coverage. And most are treated at smaller hospitals and oncology practices that do not have the staffing and resources to specialize in precision oncology or support the rapid process changes these new discoveries require.

Ellis is looking to change that. This summer, she was awarded a $1.2 million R01 grant from the National Cancer Institute (NCI) to test an intervention she and her colleagues designed known as TEAMSPORT (Multi-TEAM Systems Framework Precision Oncology Reflex Testing). The goal of TEAMSPORT is to create a standardized approach to the ordering of genomic tests, on which precision medicine targeted therapies are based,  and adapt it for use in community cancer centers, where most cancer patients in the United States receive care.

“What we did in our study is design an intervention so that it will fit in rural care delivery environments,” said Ellis. “My goal is to make sure that the care that's delivered in rural communities is as good as the care that's delivered in larger communities.”

The science of delivering the science

This kind of research is rare: less than 1% of research on cancer genomics addresses how to actually deliver genomic medicine to patients. And it is based on a relatively new field known as implementation science. Just as there is a science to creating tests to evaluate which drugs work best to treat someone’s cancer, there is also a science to making sure that that those tests, and the treatments they indicate, make their way into routine clinical practice. That’s the role of implementation scientists.

Implementation scientists also work to improve care delivery processes, which includes shortening the time it takes for patients to receive a detailed diagnosis and treatment.

“Before precision oncology, a patient got a biopsy or surgery to remove their tumor, a pathologist looked at it to stage the tumor, which helps determine what treatment they should have, and then they visited their oncologist to start treatment. Now, in this new treatment era, when the oncologist realizes that they need to get a genomic test, that adds several more weeks, potentially months, before they get the results of that test,” said Ellis. “So that just extends the amount of time before these really worried patients can actually get care. Our intervention is designed to help them get treatment decisions much more quickly.”

It also makes sure that those treatment decisions align with ever-changing national guidelines and recommended approaches.

“At an academic institution like ours, we have nationally renowned oncologists that are running national studies and changing how we should treat a patient based on these new molecular diagnostics,” said Andrew Godwin, Ph.D., deputy director of , director of the Kansas Institute for Precision Medicine, division director of Genomic Diagnostics, and co-principal investigator on TEAMSPORT. “But not all oncologists and pathologists have the same level of knowledge and training in molecular oncology. And that was the basis of the TEAMSPORT grant, to see if we can standardize approaches to test clinical samples and then more effectively treat patients.”

It's a team sport

To make genomic testing routine and shorten the turnaround time for results, the TEAMSPORT intervention incorporates “reflex” (automatic) genomic testing, based on standardized national guidelines, into the workflow of pathology departments, rather than oncology departments. Oncology providers, Ellis noted, often are not permanent providers in rural communities, but pathology groups usually are. Oncologists also are typically responsible for interpreting results and making treatment decisions, whereas pathologists are responsible for preparing the tumor tissue and figuring out what kind of cancer it is, so they may be better positioned to order and manage testing on these tissues.

Another key aim of TEAMSPORT is to create an environment where the surgical, pathology and oncology teams do not work in siloes, but rather have shared goals.

“We are very good at training cancer care providers in their area of specialty, but we do very little to train them how to work across teams to make sure everything we know about a patients’ cancer is communicated and executed across teams of providers,” Ellis said.

Initially, TEAMSPORT will be implemented at The University of Kansas Health System in Kansas City. Ellis hypothesizes that the intervention will lead to a 25% increase in patients receiving this genomic testing while also reducing the time it takes to test to under 10 days for most patients.

The next step, Ellis said, would be implement TEAMSPORT more broadly at community cancer centers across the region and elsewhere. The overall result should be a decrease in disparities in clinical outcomes for rural cancer patients.

“The University of Kansas Medical Center is in a really great position to be a national leader in this kind of work; it’s part of being an NCI-designated Comprehensive Cancer Center,” said Simon Craddock Lee, Ph.D., MPH, chair of the Department of Population Health and an implementation scientist. “We have the comparative opportunity to optimize care delivery here in the Kansas City region, then adapt that for rural Kansas. That generalizable learning can then advance cancer care delivery across the rest of the country.”