By: Harala Halevi. Promoted content sponsored by Roche, a representative of Foundation Medicine in Israel
Comprehensive genomic tests are the most advanced tests to diagnose cancerous tumors, and with them it is possible to test genomic changes in a large number of genes at the same time. These tests may sometimes indicate additional treatment options. What parameters should be taken into account when choosing a test?
Cancer is not one disease that is the same for all patients, but a disease that is classified into many subtypes, which share a central feature: cells that divide repeatedly without control and may spread to nearby tissues. What makes cancer unique is the location where the tumor started and its genetic makeup.
The gene composition of the tumor, known as the genomic profile, is diagnosed by genomic testing. The principle of testing DNA and different molecules in cancerous tumors is not new. Genomic tests help to locate mutations and genomic changes in the tumor cells, and depending on the information received, the doctors can know what the expected course of the disease is (prognosis) and whether a certain treatment can be suitable for the tumor being tested.
Comprehensive genomic tests are the most advanced tests to diagnose cancerous tumors, and with them mutations and changes in dozens and hundreds of genes can be checked at the same time. These tests may sometimes reveal additional treatment options that have not yet been taken into account, and some can even predict the likelihood that the tumor will respond to a certain treatment.
In certain cases, when the cancer is advanced or rare or when treatment options have been exhausted, doctors may recommend a comprehensive genomic test. Around the world and in Israel, there are various types of comprehensive genomic tests. Since these tests are not included in the health basket, except for lung cancer under certain conditions, patients and their family members have to finance these tests privately and they can choose which type of comprehensive genomic test they will perform. Due to the complex nature of the test, there is a lot of data to consider.
What type of information will you receive in the inspection report?
Comprehensive genomic tests produce a report detailing the mutations and changes found in the genes of the tumor. Some of the tests also specify which drugs are suitable for the mutations found, and what is the level of scientific evidence in the professional literature that supports this or that treatment and whether there are relevant research drugs. These tests are based on extensive databases that, among other things, also include databases from previous tests that were performed, and perform an in-depth and accurate analysis as much as possible on each tumor that is tested. As the test provides more comprehensive information and is based on larger data bases and experience, the more insights you can get that help with therapeutic decisions.
Will you have to pay a test preparation fee? Or cancellation fees?
Comprehensive genomic testing requires a tissue sample from the tumor. Sometimes, the sample is sent to the laboratory and there they discover that the quality of the sample is insufficient or the sample is too small, and the patient is required to send a new sample. There are companies that charge a separate fee for each of the test sections, for example sample preparation at the local laboratory, a nurse to the home to take a liquid biopsy when necessary, additional test fees for preparing a new sample, cancellation fees and more. On the other hand, there are companies that charge a flat price for a comprehensive genomic test, and it includes all the test sections, without additional costs, even in the case of canceling the test or when it is necessary to prepare a new sample or take a liquid biopsy. In any case, it is important to check in advance what the conditions are for canceling the test you have chosen.
Is the test approved by the health authorities?
In Israel there are several comprehensive genomic tests that have received the approval of the Ministry of Health and the approval of other authorities around the world. As of today, there is only one comprehensive genomic test marketed in Israel and approved by the American Food and Drug Administration (FDA). The FDA approval confirms the reliability and accuracy of genomic testing to identify mutations and genomic changes in tumors and to adapt targeted treatments to different tumors. It is recommended to check which approvals have been given for the comprehensive genomic test you have chosen.
Does your insurance company have an arrangement with genomic tests?
A comprehensive genomic test is not included in the public health basket, except for lung cancer under certain conditions, and is therefore not covered under the basic insurance of the health funds, and refunds are given only in some supplementary insurances. Private insurance policies, such as critical illness insurance or extended drug insurance, can cover the cost of advanced tests and treatments that are not included in the basket. Although the insurance companies do not require you to choose a specific type of comprehensive genomic test, it is recommended to check whether the insurance company has an arrangement with the testing provider. The meaning of this arrangement is that the testing provider deals directly with the insurance company with regard to the claim and the test itself. In this way, the tedious claim process is saved from the patient, and the payment is not required to be made independently (with the exception of deductibles in certain cases), but the insurance company pays directly to the testing provider in the arrangement.
If you need a blood test ("liquid biopsy"), will you be able to use a home nursing service?
A liquid biopsy is performed by a simple blood test, but it is a test that is collected in a special kit, so the blood sample cannot be taken in any laboratory. There are genomic tests that provide a "nurse to the house" service, in which a nurse comes to your home to take the dedicated blood test for the genomic test. The nurse coordinates the date of her arrival with the patient, arrives with all the necessary equipment, and the sample is collected by a courier who specializes in this type of deliveries. Some companies charge a separate fee for this service, and there are companies that this service is included in the cost of the test.
In any case, in order to perform a comprehensive genomic test, the treating oncologist must be consulted.
The article is sponsored by Roche, the representative of Foundation Medicine in Israel
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