Genomic Testing Resources Differ by Geography and Practice Type, According to a Nationally Representative Study

Findings from a Nationally Representative study indicated that multispecialty, academically affiliated, urban cancer institutions had more access to genetic testing.

Resources for genetic cancer testing appeared to vary by geography and practice time when assessing a nationally representative sample of practicing oncologists, the implications of which could support more readily available precision care, according to a study published in the Journal of Clinical Oncology Precision Oncology.

Findings from the study indicated that practices in rural areas were significantly less likely to have on-site pathology, genetic counselors, protocols for genomic tests, and molecular tumor boards, compared with urban areas. Additionally, multispecialty group and academic practices were more likely to have testing resources available vs solo and nonacademic practices. Investigators also found that electronic medical record alerts were the least available resource, and contracts with outside laboratories were the most readily available.

“Oncologists are increasingly using molecular profiling to inform cancer treatment decisions. Our study suggests that there are variations in the availability of genomic testing resources by the oncology practice type and geographic setting,” study investigators wrote.

A total of 1281 oncologists completed the survey. It was reported that 63.1% of practices included in the study were academically affiliated, and 95.7% practiced in urban settings. Additionally, 41.8% of group practices were single specialty and 44.8% were multispecialty. A larger number of oncologists who practiced in a multispecialty group and were academically affiliated reported having genomic testing resources compared with solo practices, single-specialty, or nonacademic practice.

Results from the survey indicated that 69.9% of oncologists reported their primary practice had on-site pathology. Multispecialty academic groups were significantly more likely to have on-site pathology. On-site pathology did not differ by rurality (adjusted odds ratio [aOR] 1.14; 95% CI, 0.56-2.32).

Moreover, 85.6% of oncologists reported that their primary practice had contracts with outside laboratories. Those with single-specialty nonacademic group (aOR, 0.58; 95% CI, 0.40-0.90) and solo nonacademic practices (aOR, 0.29; 95% CI, 0.13-0.65) were noted as being less likely to have contracts with outside laboratories vs multispecialty academic groups. Additionally, investigators did not note any differences in contracts with outside laboratories by rurality (aOR, 2.10; 95% CI, 0.83-5.31).

Investigators stated that 67.3% of oncologists reportedly had genomic counselors on site at their primary practice. Those working within multispecialty academic groups were the most likely to have counselors on-site compared with other specialties and practices. It was found that rural practices were 70% less likely to have on-site counselors compared with urban practices (aOR, 0.30; 95% CI, 0.14-0.63).

Almost half (48.1%) of oncologists reported having internal protocols for genetic testing within their primary practice. Multispecialty group academic practics were more likely internal testing protocols when compared with other practices, such as multispecialty nonacademic groups (aOR, 0.24; 95% CI, 0.15-0.36). Investigators did not find a difference in internal protocols for genomic tests by rurality (aOR, 0.54; 95% CI, 0.27-1.07).

Additional findings from the study indicated that 16.8% of oncologists that had electronic medical record alerts at their primary practice. However, the odds of having these alerts were significantly lower in single specialty groups compared with multispecialty groups (aOR, 0.52; 95% CI, 0.32-0.83). No significantly differences were noted based on alerts in terms of the type of practice or rurality (aOR, 0.46; 95% CI, 0.16-1.31).

In closing, investigators reported that 36.3% of oncologists had a molecular tumor board at their practice, with multispecialty groups being more likely to have a board than other practices, such as multispecialty nonacademic groups (aOR, 0.14; 95% CI, 0.08-0.24). It was reported that rural practices had 80% lower odds of having molecular tumor board when compared with practices in an urban setting; this was found to be statistically significant (aOR, 0.20; 95% CI, 0.06-0.64).


Gardner B, Doose M, Sanches J, et al. Distribution of genomic testing resources by oncology practice and rurality: a nationally representative study. JCO Precis Oncol. 2021;5:1060-1068. doi:10. 1200/PO.21.00109