The Community Oncology and Academic Medical Center Alliance in the Age of Precision Medicine: Cancer Genetics and Genomics Considerations

Abstract

<jats:p>Recent public policy, governmental regulatory and economic trends have motivated the establishment and deepening of community health and academic medical center alliances. Accordingly, community oncology practices now deliver a significant portion of their oncology care in association with academic cancer centers. In the age of precision medicine, this alliance has acquired critical importance; novel advances in nucleic acid sequencing, the generation and analysis of immense data sets, the changing clinical landscape of hereditary cancer predisposition and ongoing discovery of novel, targeted therapies challenge community-based oncologists to deliver molecularly-informed health care. The active engagement of community oncology practices with academic partners helps with meeting these challenges; community/academic alliances result in improved cancer patient care and provider efficacy. Here, we review the community oncology and academic medical center alliance. We examine how practitioners may leverage academic center precision medicine-based cancer genetics and genomics programs to advance their patients’ needs. We highlight a number of project initiatives at the City of Hope Comprehensive Cancer Center that seek to optimize community oncology and academic cancer center precision medicine interactions.</jats:p>

Distribution of Genomic Testing Resources by Oncology Practice and Rurality: A Nationally Representative Study

“…34 To address this gap, academic medical centers and larger health systems have been actively involved in targeted efforts to bring precision medicine to diverse health care settings. 35,36 For example, collaboration through community-academic partnerships and the development of decentralized, online resources have provided infrastructure for many patients in nonacademic practice settings to benefit from precision oncology advances. [35][36][37] Genomic testing resources also varied between urban and rural practices, such that a smaller proportion of rural practices had on-site genetic counselors, internal protocols for genomic tests, on-site pathology, and molecular tumor boards compared with urban practices.…”

“…35,36 For example, collaboration through community-academic partnerships and the development of decentralized, online resources have provided infrastructure for many patients in nonacademic practice settings to benefit from precision oncology advances. [35][36][37] Genomic testing resources also varied between urban and rural practices, such that a smaller proportion of rural practices had on-site genetic counselors, internal protocols for genomic tests, on-site pathology, and molecular tumor boards compared with urban practices. These findings are consistent with previous studies indicating limited availability of cancer care services in rural settings.…”

Characterizing the relationships between tertiary and community cancer providers: Results from a survey of medical oncologists in Southern California

“…The City of Hope network consists of a tertiary center, designated as an NCI‐CCC, and 30 community practice sites within a 100 mile radius in Southern California. Recent reports from physicians in the City of Hope network have highlighted the efficiencies and limitations of this care model 20–26 …”

“…Recent reports from physicians in the City of Hope network have highlighted the efficiencies and limitations of this care model. 20 , 21 , 22 , 23 , 24 , 25 , 26 These pieces noted increased trial accrual, implementation of cancer screening programs, and integration of precision medicine efforts, among other collaborative measures, at affiliated community sites as favorable consequences of the tertiary–community partnership. The City of Hope model and similar partnerships nationwide may potentially ameliorate differences in oncology practice and outcomes between tertiary and community sites discussed in this study and other referenced publications.…”

“Doing Good” in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology

“…In US-based biomedicine, however, most oncology care is delivered in community oncology practices which are historically distinct and geographically distant from academic medical centers where genomic technologies have been developed and previously evaluated ( Ball et al . 2020 ; Melas et al . 2020 ).…”