Impact of sociodemographic factors on molecular testing patterns in localized and metastatic malignancies.

Abstract

e13510 Background: Next-generation sequencing (NGS) identifies actionable mutations that guide precision therapy in both localized and metastatic cancer. This study evaluated sociodemographic factors associated with NGS timing and outcomes across malignancies. Methods: Patients undergoing tissue NGS at a single institution through Caris Life Sciences were identified and grouped as having localized or metastatic at the time of testing. Associations between sociodemographic variables and time from diagnosis to NGS and overall survival (OS) were evaluated using log-linear regression, Cox proportional hazards models, and Kaplan-Meier analysis (p < 0.05 significant). Results: Among 913 patients, 43.8% were female, 33.4% non-white, 17.1% Hispanic, 8.8% non-English speaking, 7.7% veterans, and 29.9% reported disabilities. Median age at diagnosis was 60.5 years. The most common primary malignancies were skin (15.6%), colorectal (15.4%), pancreas (7.2%), and prostate (7.1%). Insurance included Medicare (47.6%), private/commercial (37.7%), and Medicaid/Medi-Cal (13.3%). 354 (39.3%) patients had localized disease and 547 (60.7%) had metastatic disease at time of NGS. Median time from diagnosis to NGS was 4.1 months for localized and 4.2 months for metastatic disease. In adjusted analysis among patients with localized disease at time of NGS, patients with Medicare underwent NGS later than patients with Medicaid (p = 0.007). Among patients with metastatic disease at time of NGS, older age was associated with shorter time to NGS (p = 0.001), and female sex was associated with longer time to NGS (p = 0.03). Median follow-up was 43.2 months. Among patients with metastatic disease, 127 (24.7%) underwent NGS testing within 6 months of death. Disability was associated with lower odds of testing within 6 months of death (OR = 0.59, p = 0.02), while race, insurance, and other SES factors were not significantly associated with this outcome. Among patients with localized disease, 52 (15%) underwent testing within 6 months of death. Overall, 416 (75.0%) of patients with metastatic disease harbored alterations with FDA-approved targeted therapies available compared to 244 (70.1%) in localized disease. In multivariable Cox models stratified by primary tumor, worse OS was associated with increasing age (localized HR = 1.04/year, p < 0.001; metastatic HR = 1.01/year, p = 0.02) and Medicaid (localized HR = 6.66, p < 0.001; metastatic HR = 1.58, p = 0.03). Conclusions: Sociodemographic factors influenced NGS timing and survival. Medicaid was associated with worse OS across both localized and metastatic disease, while Medicare was associated with delayed NGS in localized disease. Age and sex also affected time to NGS in metastatic patients. These disparities highlight the need for interventions to ensure equitable access to precision oncology.