Impact of social determinants of health (SDOH) on disparities in next-generation sequencing (NGS) testing in cancer patients (pts) in the US

BackgroundIn the US, 5 most common advanced/metastatic (met/adv) solid tumors are metastatic non-small cell lung cancer (mNSCLC), metastatic breast cancer (mBC), metastatic prostate cancer (mPC), metastatic colorectal cancer (mCRC), and metastatic pancreatic cancer (mPanC). Current guidelines recommend NGS testing for pts with these malignancies due to approved life-prolonging therapies for pts with driver mutations. However, large cohort studies evaluating disparities in NGS testing have not been reported. Herein, we investigated the effect of SDOH on disparities in NGS testing in these tumors.MethodsIn this IRB-approved retrospective study, pt-level data were extracted from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Inclusion criteria: pts diagnosed with mNSCLC, mBC, mPC, mCRC, and mPanC between 2018 and 2022, with available treatment information. Disparities in the rates of NGS testing were assessed by socioeconomic status (SES), race-ethnicity (R/E), region, and insurance were assessed using Fine and Grey’s modified Cox proportional hazard model with NGS testing as the event of interest and death as a competing risk. Different baseline hazards by the year of met/adv diagnosis were assumed. Complete case analysis was performed for each analysis. All analysis was done using R v.4.2.3.ResultsThe analytic cohort included 21964, 9872, 3560, 10942, and 4945 pts with mNSCLC, mBC, mPC, mCRC, and mPanC, respectively. Pts with lower SES were less likely to receive NGS testing. Results are summarized in the table. Further disparities in NGS testing by R/E, insurance type, and region will be presented in the meeting. Impact of SES on NGS testing (HR>1 indicates more NGS testing). Table: 1580P Cancer SES mNSCLCn=21964 mBCn=9872 mPCn=3560 mCRCn=10942 mPanCn=4945 5 –High (reference) HR (95% CI) - - - - - 4 0.97 (0.93 – 1.01) p=0.13 1.02 (0.94 – 1.11) p=0.58 0.99 (0.89 – 1.10) p=0.80 1.05 (0.99 – 1.11) p=0.11 1.05 (0.96 – 1.14) p=0.28 3 0.91 (0.87 – 0.95) p<0.001 0.92 (0.84 – 1.00) p=0.04 0.91 (0.81 – 1.02) p=0.10 1.05 (0.99 – 1.12) p=0.11 1.00 (0.91 – 1.09) p=0.96 2 0.83 (0.80 – 0.87) p<0.001 0.89 (0.82 – 0.97) p=0.009 0.90 (0.80 – 1.01) p=0.09 0.92 (0.87 – 0.98) p=0.008 0.99 (0.90 – 1.09) p=0.85 1-Low 0.78 (0.75 – 0.82) p<0.001 0.83 (0.76 – 0.91) p<0.001 0.77 (0.68 – 0.87) p<0.001 0.83 (0.78 – 0.88) p<0.001 0.85 (0.77 – 0.93) p=0.001 ConclusionsOur findings suggest that pts with lower SES were less likely to get NGS testing, potentially reducing access to life-prolonging therapies. These results highlight the need for policies to mitigate this disparity.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureS. Roy: Financial Interests, Research Grant: Prostate Cancer Foundation, Swim Across America Foundation; Financial Interests, Speaker, Consultant, Advisor: Varian Medical Systems. B.L. Maughan: Financial Interests, Speaker, Consultant, Advisor: AbbVie, Pfizer, AVEO oncology, Janssen, Astellas, Bristol Myers Squibb, Clovis, Tempus, Merck, Exelixis, Bayer Oncology, Lilly, Sanofi, Telix, Xencor, NCCN, Peloton Therapeutics; Financial Interests, Research Funding: Exelixis, Bavarian-Nordic, Clovis, Bristol Myers Squibb. U. Swami: Financial Interests, Personal, Writing Engagement: Astellas; Financial Interests, Personal, Advisory Board: SeaGen, Exelixis, AstraZeneca, Adaptimmune, Gilead, Imvax, Pfizer, Sanofi; Financial Interests, Institutional, Research Grant: Janssen, Exelixis; Financial Interests, Institutional, Local PI: Astellas/Seattle Genetics. N. Agarwal: Financial Interests, Personal, Invited Speaker, Invited speaker: Medscape; Financial Interests, Personal, Invited Speaker, Invited Speaker: Onclive, Research to Practice, Clinical Care Options; Financial Interests, Institutional, Other, I serve in the leadership of my cancer center (Huntsman Cancer Institute, University of Utah. Salt Lake City, UT, USA). There are multiple research projects sponsored by these companies which pay money to my institution: Arnivas, Astellas, AstraZeneca, Bavarian Nordic, Bayer, Bristol Myers Squibb, Calithera, Celldex, Crispr, Eisai, Eli Lilly, EMD Serono, Exelixis, Genentech, Gilead, GSK, Immunomedics, Janssen, Lava, Medivation, Merck, Nektar, Neoleukin, New Link Genetics, Novartis, Oric, Pfizer, Prometheus, Rexahn, Roche, Sanofi, Seattle Genetics, Takeda, Telix, Tracon.; Financial Interests, Steering Committee Member, I am involved in the steering committee of the trials sponsored by these pharmas with no personal honorarium: AstraZeneca, Calithera, Crispr, Eli Lilly, Exelixis, Immunomedics, Merck, Pfizer,; Financial Interests, Steering Committee Member, I am involved in the steering committee of the trials sponsored by these pharma companies with no personal honorarium: Merck, Nektar, New Link Genetics, Oric, Pfizer, Prometheus, Rexahn, Takeda, Telix,Tracon; Financial Interests, Trial Chair, One of the two co-chairs of the clinical trials sponsored by these pharma companies. I have not received any honorarium for these roles.: Pfizer, Exelixis, Janssen, Telix.; Non-Financial Interests, Member, I am a long-standing member of ASCO and a volunteer. I was awarded the fellow of ASCO in 2023. I also act as the editor of the ASCO Daily News as a volunteer.: Amercian Society of Clinical Oncology; Non-Financial Interests, Member, I am a member of this NCI and NCTN-sponsored cooperative clinical trial network group: SWOG; Non-Financial Interests, Member, I am a member of these professional organizations.: AACR, AUA, PCF. All other authors have declared no conflicts of interest.