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PURPOSE: Precision therapies and immunotherapies have revolutionized cancer care, with novel genomic biomarker-associated therapies being introduced into clinical practice rapidly, resulting in notable gains in patient survival. Despite this, there is significant variability in the utilization of tumor molecular profiling that spans the timing of test ordering, comprehensiveness of gene panels, and clinical decision support through therapy and trial recommendations. METHODS: To standardize testing, we designed a pathologist-directed test ordering system at the time of diagnosis using a 523-gene DNA/RNA hybrid comprehensive genomic profiling (CGP) panel and extensive clinical decision support tools. To comprehensively characterize the clinical impact of this protocol, we developed a novel natural language processing (NLP)–based approach to extract clinical features from physician chart notes. We assessed test actionability rates, therapy choice, and outcomes across a set of 3,216 patients with advanced cancer. RESULTS: We observed 49% of patients had at least one actionable genomic biomarker-driven–approved and/or guideline-recommended targeted or immunotherapy (IO) and 53% of patients would have been eligible for a precision therapy clinical trial from three large basket trials. When assessing CGP versus an in silico 50-gene panel, 67% of tumors compared with 33% harbored actionable alterations including clinical trials. Among patients with 6 months or more of follow-up, over 52% received a targeted therapy (TT) or IO, versus 32% who received conventional chemotherapy alone. Furthermore, patients receiving TT had significantly improved overall survival compared with patients receiving chemotherapy alone (P <.001). CONCLUSION: Overall, these data represent a major shift in standard clinical practice toward molecularly guided treatments (targeted and immunotherapies) over conventional systemic chemotherapy. As guidelines continue to evolve and more precision therapeutics gain approval, we expect this gap to continue to widen. Current utilization patterns for tumor genomic testing are highly variable because of a variety of factors including lack of access and socioeconomic barriers. Here, we developed a program to attempt to remove many of these barriers and provide genomic testing rapidly as possible. Evaluating results over a multiyear period, we found around half of the patients tested with comprehensive genomic profiling had an actionable biomarker. Tested patients also received precision therapies at a higher rate than conventional chemotherapy alone, which was associated with higher overall survival across the real-world cohort. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has impacted health care delivery worldwide. Cancer is a leading cause of death, and the impact of the pandemic on cancer diagnoses is an important public health concern. Methods: This cross‐sectional study retrospectively analyzed the electronic medical records of 80,138 cancer patients diagnosed between January 1, 2019, and May 31, 2021. Outcome measures included weekly number of new cancer cases and trends in weekly cancer cases, before and after the pandemic; patient demographics; and positive COVID‐19 test rates. Results: Beginning March 4, 2020, defined as the onset of the pandemic, weekly cancer cases declined precipitously (–110.0 cases per week [95% confidence interval, −190.2 to −29.8]) for 4 weeks, followed by a moderate recovery (+23.7 cases per week [9.1 to 38.4]) of 10 weeks duration. Thereafter, weekly cancer cases trended slowly back toward pre‐COVID‐19 baseline levels. Following the pandemic onset, there was a cumulative year‐over‐year decline in cancer cases overall of 7.3%, including a 20.2%, 14.3%, and 12.8% decline in nonmelanoma skin cancer, breast cancer, and prostate cancer, respectively. Changes in case volumes were accompanied by variations in patient characteristics, including region, age, gender, race, insurance coverage, and COVID‐19 positive test rates (P <.01 for all). Among patients tested for COVID‐19, 5.3% had a positive result. Conclusions: The data in this study demonstrate a substantial reduction in cancer diagnoses following the onset of COVID‐19, which appear to reach expected pre‐COVID norms 12 months later. The largest reduction was noted among cancers that are typically screen‐detected or identified as part of a routine wellness examination. The data in this study demonstrate a substantial reduction in cancer diagnoses following the onset of COVID‐19, which appear to have reached expected pre‐COVID norms roughly 1 year after the onset of the pandemic. [ABSTRACT FROM AUTHOR]