Dr Sigrun Hallmeyer Discusses Why a Team Effort Is Vital in Precision Medicine

Precision medicine starts with the patient-physician relationship, but it also includes identifying the right laboratory to answer the clinical question at hand and being comfortable with discussing molecular testing, which involves an entire care team, emphasized Sigrun Hallmeyer, MD, medical oncologist with Advocate Health.

Transcript

Can you discuss the role of a patient navigator for patients currently receiving or set to receive targeted treatment for cancer?

I wish there was such an individual that exists. Ultimately, a cancer patient typically is advocated [for] by their oncology care team that is led by the oncologist. The unfortunate truth of that is that much of the precision medicine interaction starts with the patient-physician relationship: identifying the right patient for the right test at the right time in their treatment trajectory.

Once that has taken place, still a whole host of different things needs to happen, from which laboratory do I utilize to answer the clinical question that I have in front of me to identify a target that could potentially help me change the trajectory of my care plan for that patient, because I am finding a target that I can potentially treat with the medication that is utilizing that particular target. And so a champion in that regard would be somebody who is very comfortable in the environment of discussing molecular testing, which is a very complex concept, with their oncology patient and has the expertise of knowing which laboratory will provide the right test from the right material—Is it tumor tissue? Is it blood, like a liquid biopsy? Is it saliva?—whatever it might be, to answer the clinical question on hand and furthermore has the logistical wherewithal in their office to know how to order the test?

Do I need to log on to a portal? Is there a paper requisition that needs to be faxed to the laboratory? And then with all that comes a whole host of other supportive staff that now needs to make sure that the specimen gets sent from the pathology laboratory to the testing laboratory, is received in the testing laboratory, the quality control has happened there, the specimen is sufficient for testing, then the result is received back with the physician, has been acknowledged by the physician and translated into a discussion at the bedside with the patient.

Not to even let alone that these results are super complex and may result in, yes, actionable mutations that the physician may be very familiar with and know what to do with, but it may also be a lot of what we call garbage or, you know, white noise. Lots of information on mutations or variations of unknown significance that may actually not influence the trajectory of the treatment, but may very well take away valuable time in the visit with the patient for the physician to explain, “Well, here's what the result means, and unfortunately, it's not actionable.”

So long-winded answer to your short question, who is the champion? It's not a one-person deal. It's a team effort that starts with the patient-physician relationship, but involves an entire care team, the logistical sort of staff that needs to be in place in order for all this to work.