ASPO Abstracts
Receipt of Next-generation Genomic Sequencing among Patients with Metastatic Colorectal Cancer (mCRC) in a Real-World Cohort
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose of the Study: Disparities in genomic precision medicine approaches, through molecular profiling or next-
generation sequencing (NGS), by race/ethnicity, insurance, and poverty have been identified in lung cancer, but
not mCRC. Our goal was to examine disparities in receipt of NGS in patients with mCRC.
Methods: We used all-payer electronic health record (EHR)-derived de-identified data from the Flatiron Health
database generated from routine clinical care across the United States. Our study population included 26,524
patients with mCRC during the years 2013-2020. In addition to date of NGS testing, the FH-EHR data include
demographics (age, sex, and race/ethnicity), payer type, and Eastern Cooperative Oncology Group (ECOG)
performance status. We conducted descriptive analyses and multivariable logistic regression analysis to identify
correlates of receipt of NGS within 6 months of metastatic diagnosis.
Results: Among the 26,524 people with mCRC, 45% (n=11,946) were women, 48% (n=12,732) had a Commercial
Health Plan, and the majority were seen in a community practice (92%) vs academic hospitals. Over 70% of the
patients were White, 12% Black or African-American (AA), and 14% Other. Thirty-three percent (n=8,821) of
patients had documentation in the EHR of having received NGS. After simultaneously adjusting for other factors in
the model, older age (ORper year increase: 0.97, 95% CI: 0.96-0.98) and Black/AA race (OR: 0.74, 95% CI: 0.68-
0.81), compared to White, was associated with lower odds of receiving NGS testing. Conversely, female sex,
better ECOG performance status, later calendar year, being seen in an academic practice, and having a
Commercial Health Plan were associated with greater odds of receiving NGS.
Conclusions: Our findings indicate that NGS is not received uniformly by all patients with mCRC. Future analyses
will incorporate receipt of individual molecular biomarker tests, as recommended by professional societies, as well
as their results (e.g., KRAS, NRAS, BRAF, MMR/MSI), treatment information, and survival.
Keywords: next generation sequencing disparities metastatic CRC