Veteran Healthcare System: A Unique Healthcare Setting Providing Equitable Access to all Patients with Metastatic Lung Cancer in the Era of Precision Diagnostics

Abstract

Abstract Introduction/Objective The National Comprehensive Cancer Network (NCCN) Non-Small Cell Lung Cancer (NSCLC) Guidelines Panel strongly advises broad molecular tumor profiling to identify mutations that help guide precision- based patient tailored therapy and subsequent patient counseling. Liquid biopsy with next generation sequencing represents a powerful tool to obtain this information through phlebotomy but is costly and only recently available. Although ethnic minorities may not have the same access to health care resources, studies of ethnic access to liquid biopsies in the setting of Veteran patients at a Veteran Affairs Medical Center (VAMC) with metastatic lung cancer have not been well studied. Methods/Case Report A retrospective review was performed of all patients with a submitted liquid biopsy specimen at a VAMC and a history of metastatic lung cancer from November 26th, 2019, to March 3rd, 2023. Demographic data was collected for each patient specimen and compared with the ethnic proportions noted in the census of the city where the VAMC is located. Results (if a Case Study enter NA) There were a total of 35 patient specimens, with the first liquid biopsy collection occurring on November 26th, 2019. The mean age of the patients was 70. The ethnic composition of the population was as follows: 16 were African American (45.7%), 16 were Caucasian American (45.7%), 2 mixed ethnicity (5.7%), and 1 declined to answer or were of unknown ethnicity (2.9%). The census of the surrounding metropolitan area demonstrated a general population ethnic composition of 43.6% African American and 44.4% Caucasian American. Conclusion The proportion of Veteran patients of each ethnicity with metastatic lung cancer that received liquid biopsy testing was similar to the ethnic distribution of the general population of the surrounding metropolitan area. This demonstrates that there was equitable access to this testing modality at the VAMC with potential to deliver best cancer care to the veterans by detection, prognosis, and monitoring treatment outcomes.