Genetic services, like nearly all other medical specialties, have been impacted by the current COVID-19 pandemic. Restrictions to outpatient services, which began in March 2020, resulted in a cascade of events. The most significant of these were limitations in patient access — both to the professional guidance of genetic counselors, as well as essential genetic testing used in the management of a myriad of diseases.
Although telehealth services had been less frequently utilized up until the pandemic, it has become an essential and convenient tool offered to patients during this unique time. InformedDNA has long been a believer in virtual health — being the first independent provider of telegenetic counseling starting in 2007 — and has been able to respond to the circumstances unique to this pandemic, offering convenient telegenetic counseling.
Since InformedDNA works with many of the largest health plans in the U.S., we queried prior authorization requests for commercial and government clients in late 2019 and 2020. These request volumes were categorized as:
- “Pre-COVID” (December 2019 – February 2020, as baseline)
- “Initial Response” (March 2020 – May 2020) when reactive measures began to take place
- “Reopening Period” (June 2020 – August 2020) where phased re-openings took place across large portions of the country
- “Second Wave” (September 2020 – December 2020) in which confirmed cases increased beyond case counts that were present at the beginning of the pandemic (early 2020)
We focused on oncology-related testing in our data review, as genetic testing is so tightly correlated to downstream treatment and surveillance. Any delays in hereditary cancer testing and tumor testing can have significant ramifications on care.
Genetic test requests determined to be related to hereditary cancer diagnoses decreased quite significantly during the “Initial Response Period,” and began to rebound during the “Reopening Period.” Utilizing ICD-10 diagnosis codes, we compared ordering practices of those cases coming in with personal histories of cancer versus those whose indication was family history. In general, test request volumes for patients with a personal history of cancer did not decrease as dramatically as those with a family history indication (25% and 45% reduction respectively). With a personal history of cancer, treatment plans more directly depend on genetic test results, and thus, higher priority for testing is likely in this clinical scenario. Fortunately, hereditary cancer test requests have recovered completely overall, at 9% above baseline compared to December 2019 volumes.
While tumor testing did decrease in volume, there was a modest recovery at 4% below baseline in the reopening period. By the end of 2020, tumor testing recovered completely at 16% above baseline. This test category is interesting because, while the test methodology requires a tumor sample, affected individuals are likely undergoing treatment regardless of the state of the pandemic, and thus implicitly have greater access to healthcare services, making tumor sampling less of a barrier to genetic testing. That said, any decrease in tumor testing has a significant impact on treatment planning for patients with cancer. Tumor testing for medical management is typically time-sensitive, thus the failure of requests to rise to baseline level indicates a concerning trend that patients have been missing windows for precision medical treatment.
Healthcare providers and health plans alike share concerns that failure to receive informative testing may prevent or delay necessary services. For patients with a family history of hereditary cancer, this may delay preventative screenings or lead to unnecessary screenings for patients who would have had negative testing. Patients with cancers susceptible to precision therapies may not receive the most effective treatment for the genetic makeup of their tumor. Simply put, there are risks with the delay or failure to receive genetic testing for hereditary cancer and tumor testing.
The rapidly changing landscape of pandemic response across the country is likely to continue even while the vaccine rollout is happening, and in-depth analysis by experts increases a health plan’s ability to respond with precision for its members.
At InformedDNA, we leverage the expertise of the largest, most experienced, fully employed staff of lab-independent, board-certified genetics specialists in the U.S. to help ensure that patients, health plans, health systems and hospitals, pharmaceutical companies, and healthcare providers all have access to the highest quality genetics expertise and services.