Current tests are not catching cancer recurrence early enough, say oncologists

In a new report, oncologists reveal they are seeing more and more patients with advanced cancers, and worry that current tests may not catch cancer recurrence early enough.

Based on a survey conducted by The Harris Poll on behalf of Quest Diagnostics, the new report highlights perspectives of medical and surgical oncologists about the prevalence of advanced-stage cancers, the anxieties and barriers they believe patients face in accessing care, and the need for better post-treatment tools.

It also provides novel insights into the perceptions of oncologists of an emerging area of clinical testing: ctDNA minimal residual disease (MRD) blood tests to aid in monitoring for residual or recurring cancer in patients treated for solid tumours.

“We call it the cancer paradox: As medical advances improve longevity, more patients than ever face the looming risk of cancer recurrence – and the anxieties and challenges that go with it,” said board-certified oncologist Yuri A. Fesko, senior vice president and chief medical officer, Quest Diagnostics.

“Our new survey reveals the unique challenges oncologists face at a time when an unprecedented number of Americans are alive following cancer treatment but for whom the spectre of recurrence remains a real concern for both the patient and the provider.”

Despite new treatments, new cancer cases in the U.S. are expected to cross the two million mark in 2025 for the second year in a row and the number of survivors is expected to rise from 18.1 million in 2020 to 26 million by 2040. Cancer recurrence varies by type and stage, but as many as 20 to 40 per cent of the four most common solid tumour cancers – breast, colorectal, lung and prostate – recur after surgery.

Key survey findings include that 76 per cent of oncologists feel they are seeing more advanced-stage cancers, and of these, 75 per cent believe that screening barriers are the leading cause, followed by a rise in ageing population (48 per cent) and lifestyle factors (43 per cent).

Roughly one in three (32 per cent) cite “factors that we don’t understand yet” behind the perceived increase.

While 89 per cent of oncologists believe identifying cancer recurrence at the earliest possible stage can improve outcomes, roughly eight in 10 oncologists (79 per cent) report seeing patients whose cancer recurrence was missed in an earlier stage.

Of these oncologists, 68 per cent claim missing, skipping and/or delaying follow-up care and monitoring appointments is the most common reason cancer recurrence is typically missed.

87 per cent of oncologists claim anxiety/worry is among the most challenging aspects of cancer care for patients, versus 53 per cent who cite treatment side effects as among the most challenging.

Nine in 10 oncologists (89 per cent) express frustration that insurance reimbursement models are unable to keep up with the latest tech innovations in cancer care, screening, and diagnostics.

Oncologists have traditionally monitored for residual or recurring cancer using a range of expensive or invasive technologies, including positron emission tomography (PET) scans, magnetic resonance imaging (MRI), and tissue biopsies, as well as more accessible but typically nonspecific lab tests.

Yet, oncologists expressed concerns about these traditional methods. Among oncologists whose patients’ recurrence was missed in an earlier stage, half (50 per cent) said imaging tests not detecting recurrence early enough was among the primary reasons for why cancer recurrence is typically missed.

By comparison, nearly all oncologists (96 per cent) said MRD testing has the potential to identify cancer recurrence earlier than other current methods, with 89 per cent saying test sensitivity to accurately detect residual disease/recurrence as early as possible is one of the most important features of MRD tests.

“We were struck by how many oncologists cited the limitations of imaging in detecting cancer recurrence early,” said Dan Edelstein, vice president, general manager and co-founder of Haystack Oncology, a Quest Diagnostics company.

“There’s a clear desire for more sensitive tools, and oncologists increasingly see high-performance ctDNA blood tests as a promising solution for earlier detection of residual or recurrent cancer.”

Nearly nine in 10 oncologists (88 per cent) agree that MRD testing should be incorporated into the standard of care for cancer-recurrence follow-up monitoring.

However, over half say they would be more likely to start, continue, or restart recommending MRD tests if they had more clinical evidence to support effectiveness (61%), were in clinical guidelines (64 per cent), and have expanded insurance or reimbursement coverage (56 per cent).

The survey also polled oncologists on their preferences for accessing laboratory tests: 71 per cent said they prefer to work with a single laboratory with a broad selection of cancer tests spanning the care continuum versus several labs that each focus on one portion of the patient’s journey.