Abstract PO-210: Distribution of genomic testing resources by oncology practice setting and rurality: A nationally representative analysis
Authors: Gardner Brittany D. , Sanchez Janeth , Doose Michelle , Weaver Sallie J. , Srinivasan Shobha , Freedman Andrew , de Moor Janet S. 
Published: December 2020

Abstract
Purpose: This study seeks to understand how the availability of genomic testing resources for cancer treatment vary by oncology practice setting and rurality.
Background: Pervasive inequities in access to cancer care resources exist at the neighborhood and health system level. In particular, rurality and practice type have been linked to diminished access to care and poorer health outcomes. While these inequities persist, there have been many advancements in cancer care technology and oncologists are increasingly using genomic testing and next-generation sequencing technology to inform treatment decisions. Little is known about the availability of genomic testing resources in different oncology practice settings and at differing levels of rurality. Methods: This study used data from the National Survey of Precision Medicine in Cancer Treatment, the first nationally representative sample of oncologists (N=1,281) practicing in the United States. Oncologists were identified from the American Medical Association Masterfile for 2017 and were sampled by specialty, census region, metropolitan statistical area, sex, and age. The outcome, availability of genomic testing resources, was measured using one survey question asking oncologists if their primary practice has the following genomic testing resources: on-site pathology, contracts with outside labs, on-site genetic counselors, internal protocols for using genomic testing, electronic medical records (EMR) that alert providers when to order a genomic test, and molecular tumor boards. The predictor variables were rurality and practice type. Rurality was determined using Rural Urban Continuum Codes (RUCC) from 2013. Practice type was measured using the following six categories: solo practice academic, solo practice non-academic, single specialty group academic, single specialty group non-academic, multispecialty group academic, and multispecialty group non-academic. Descriptive statistics were presented, and chi-square tests were used to assess statistically significant difference. The weighted sampling design of the survey was accounted for using SAS statistical package version 9.4 (SAS, Cary NC). Results: Higher proportions of academic practices had genomic testing resources than non-academic practices.
Higher proportions of multispecialty groups had genomic testing resources compared to single specialty group and solo practices. Compared to urban practices, lower proportions of rural practices had genomic testing resources for all except contracts with outside labs and EMR alerts. Conclusion: These data highlight the unequal distribution of genomic testing resources for cancer treatment by practice type and rurality. Future studies and interventions should strive to further assess factors affecting access to cancer care resources and explore health system level approaches to improve health equity.
Citation Format: Brittany D. Gardner, Janeth Sanchez, Michelle Doose, Sallie J. Weaver, Shobha Srinivasan, Andrew Freedman, Janet S. de Moor. Distribution of genomic testing resources by oncology practice setting and rurality: A nationally representative analysis [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-210.