Potential barriers to implementation of next-generation sequencing in cancer management: a US Physician-based survey

Background: The purpose of this study was to identify barriers to physicians' NGS use and preferred strategies to alleviate these barriers. Research Design and Methods: A cross-sectional online survey link was sent to a sample of US oncologists/hematologists, surgeons, and pathologists identified through a panel. The survey collected data, from October-December 2020, on barriers to NGS testing and potential strategies. Results: Two hundred physicians participated (mean age: 46.2years; 65% male; 80% White, mean years in clinical practice: 13.7). Despite the use of NGS testing by all physicians, 99.5% reported concerns/barriers. Reimbursement challenges were the most cited reason (87.5%), followed by lack of knowledge of NGS testing methodologies (81.0%), and lack of clinical utility evidence (80.0%). The most common reimbursement challenge was prior authorizations for NGS testing (72.0%), followed by knowledge of new fee codes for reimbursement or corresponding therapy (68.0%), and paperwork/administrative duties (67.5%). Surgeons were more likely to encounter challenges in using NGS testing than other physicians. Conclusions: The results highlight the barriers reported by oncologists/hematologists, pathologists, and surgeons, which may impact the evolving role of NGS in the context of the overall management of cancer patients. Next-generation sequencing testing has begun to have an important role in the diagnosis, assessment of prognosis, and identification of appropriate targets for treatment. In this study, we surveyed oncologists/hematologists, surgeons, and pathologists to better understand the barriers to using next-generation sequencing. Reimbursement challenges were the most reported barrier. The most common reimbursement challenge was prior authorizations for next-generation testing, followed by knowledge of new fee codes for reimbursement or corresponding therapy and paperwork/administrative duties. Lack of knowledge of next-generation sequencing testing methodologies and lack of clinical utility evidence were also reported barriers. Surgeons were more likely to have challenges in using next-generation sequencing than other physicians. The results highlight the barriers reported by oncologists/hematologists, pathologists, and surgeons, which may impact the evolving role of next-generation sequencing in the clinical management of cancer patients.