Identifying and overcoming barriers to biomarker testing: a new research project from Macmillan Cancer Support and AstraZeneca

Macmillan Cancer Support and AstraZeneca are working in partnership on a new research project to understand the barriers and challenges people with cancer, professionals and the system face around biomarker testing, and in turn develop new ways for people to access the latest personalised testing for cancer.

This project has been developed as part of a Patient Advocacy Group Partnership between Macmillan Cancer Support and AstraZeneca UK Limited. AstraZeneca has provided funding to cover the costs associated with the project.

Historically, patients presenting with a particular cancer type all received the same treatment. However, it is now understood that not all patients with the same cancer type will respond to the same treatment. Biomarkers are useful tools to gain insight into a patient’s tumour and the presence or absence of biomarkers can predict response to some drug treatments.

The field of genomics has expanded rapidly in recent years and significant advancements have helped to improve the cancer tests and potential treatments available for an individual.

Biomarker - or molecular - testing refers to a laboratory method that uses a sample of tissue, blood, or other body fluid to check for certain genes, proteins, or other molecules that indicate a certain cancer and/or what is driving that cancer to grow. Molecular diagnostics, also called molecular pathology, involves taking the unique genetic code found in our cells, and analysing the sequences for red flags that can pinpoint the potential of a specific cancer.

Using precision oncology, detected genetic changes in the cancer cells – also known as the genetic or molecular tumour profile - used to inform and guide treatment choices that optimise efficiency or therapeutic benefit. The goal of precision medicine is to deliver the right cancer treatment at the right time to patients.

The latest research and advancements in genomics are all underpinned by the Genome UK strategy, as well as specific policies across the UK:

• England: Accelerating genomic medicine in the NHS
• Scotland: Genomic medicine strategy 2024-2029
• Wales: Genomics for precision medicine strategy
• Northern Ireland: Genome UK: shared commitments for UK-wide implementation 2022 to 2025

Despite the launch of the genomic medicine service in 2018 and subsequent policy to underpin direction and ambition, there are still challenges and variation in health systems across the UK. This means that not all patients who are eligible for biomarker testing are offered or undergo it to inform treatment decisions and therefore can subsequently miss out on identifying potentially lifesaving or life-extending treatments. A real-world study has shown that only 50% of patients get tested for biomarkers required for optimal treatment decisions (MyLung study). By increasing awareness and access to biomarker testing, more patients will receive the best treatment available for their cancer.

By working with people with cancer and healthcare professionals, the goal of Macmillan and AstraZeneca’s DART project is to identify the current barriers to expanding the use of biomarker testing, define changes that will improve biomarker testing, and to optimise patient access, equity and experience in precision oncology treatment across the UK.

The research project is using a mixed-method approach that includes a literature review, interviews of healthcare professionals, a patient focus group, and surveys to both patients and healthcare professionals from across the UK.

An agreed representative list of cancers was selected to ensure we included both rare and common cancers, those with well-understood and less-understood biomarkers, and encompassing a range of demographic characteristics such as sex, age and socio-economic status. The cancer types prioritised for the research were lung, breast, colorectal, sarcoma, melanoma and glioblastoma. 

The main research phase is now complete, and below is a preview of the high-level findings from the patient focus group and survey:

• A lack of support and insufficient time with healthcare professionals
• A lack of plain-language education materials
• Around half wanted more information about their treatment
• Only around half said they were aware they had received biomarker testing
• Only around a quarter of patients had received information but all of these found it useful – however, the majority received no information
• Both the focus group and patient survey highlighted the lack of information available about biomarker testing
• A lack of time in oncology appointments to discuss biomarker test results

Read more details about the patient results on this poster presented at UKONS (UK Oncology Nurse Society) 2024.

• The Macmillan Genomics Toolkit
• The Cancer Professionals Podcast
• Genomic notes for clinicians in clinic 
• Competencies of the UK nursing and midwifery workforce to mainstream genomics in the NHS