Lung cancer

Comprehensive Genomic Profiling is one of six urgent lung cancer reforms needed

Six key reforms are needed to address systemic gaps in lung cancer diagnosis and treatment in Australia, according to a new report from the Lung Foundation.

As well as implementing the recommended national lung cancer screening program, there is also a need for government-funded Comprehensive Genomic Profiling as standard of care for Australians with lung cancer and a national clinical quality registry, the Foundation argues.

Its report also calls for urgent funding for 100 specialist lung cancer nurses, renewal of stalled lung cancer prevention strategies such as smoking cessation programs – and better support for lung cancer survivors dealing with anxiety and depression.

Lung Foundation chair Mark Brooke said the report was an opportunity for the new Labor government to take action after years of inaction on the nation’s biggest cancer killer.

He said reforms were urgently needed for patients who still experienced delayed diagnosis and treatment, lack of specialist cancer care and a five year survival rate of only 20%.

“Despite incredible scientific advancements and significant new treatments now available, it is devastating to reflect, and see, that four years on from our first report of this kind released in 2018, improvements in lung cancer care across the country have been limited.

“We felt it was a watershed moment when the former Health Minister announced a scoping study on a national lung cancer screening program – but when the rubber hit the road, we’ve not seen this funded despite evidence of its impact,” he said.

“It hasn’t been good enough, but we have faith that this new government will not leave those with lung cancer behind,” said Mr Brooke.

As noted in a landmark inquiry, a national low dose CT lung screening program will save 12,000 lives over 10 years and should be funded in the October budget, the report recommends.

It also recommends that comprehensive genomic testing be funded for lung cancer patients because it will provide greater diagnostic accuracy, targeted treatment options and improved patient outcomes, as well as cost savings.

Currently, MBS-funded tests are mostly single gene tests or small panels, which means that patients endure ‘testing odysseys’ of multiple tests before a useful biomarker is identified. This approach is hampered by insufficient biopsy tissue being available for multiple successive tests, and high costs for some genomic tests.

“Inequitable clinical access to CGP is an issue in the absence of MBS funding, as only patients who can afford to pay thousands of dollars out of pocket are able to receive the tests,” the report noted.

Adopting a broader approach of CGP at the point of initial treatment planning, which typically tests 300-500 genes, has been estimated to increase overall survival by six months per lung cancer patient. The report noted that at a cost of $3000 per CGP test, the implementation as standard of care for lung cancer patients would cost $26 million a year but reduce overall care costs by 21%.

“Australians with lung cancer have high unmet clinical need for the latest personalised medicine technologies. Increasing access to CGP is a critical component to improving the quality of care that Australians with lung cancer receive,” the report stated.

“Public funding for CGP in the clinical care of lung cancer would enable equitable access to the tests needed to prescribe targeted therapies, including innovative treatment through clinical trials, and further integrate genomics into clinical practice.”

The report’s lead author, Professor Nicole Rankin, Head, Evaluation and Implementation Science Unit, University of Melbourne said the recent pandemic had highlighted the need for decisive and strong action on lung cancer detection and treatment.

“The COVID-19 pandemic has significantly impacted the Australian health system and reduced the delivery of cancer diagnostic and treatment services; many lung cancers remain undiagnosed and an influx of lung cancer referrals is expected in coming months and years,” she said.

“[This] Blueprint provides us all with a framework to drive significant and positive change over 2022- 2025 that transforms lung cancer from a fatal condition to one that is treatable.”

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