Thread by @sjwright17

Something that keeps coming up in my PhD on capacity constraints to precision medicine is the increasing strain on pathology labs. Much of the focus is on genomics and novel treatments but most of these tests involve at least some sample processing in path labs

My research on NSCLC suggests that in this area there is also a lack of clarity about how tests and test processing is paid for and in many instances its the path labs that pick up the bill. This creates tensions between test providers, test orderers and finance staff

Furthermore, new tests often need to be validated with the costs potentially running to over £5000 per lab. Again this is currently not directly reimbursed, although some drugs companies are now offering grants to do this

This is in the context of an already overstretched service. @CR_UK estimate that demand for cellular pathology is increasing by 4.5% a year while recruitment is only rising by 1.2-3% per year

cancerresearchuk.org/sites/default/…

In addition, contrary to what I have found, CRUK suggested that molecular pathology have been ok yet simply because the implementation of new stratifying tests has been poor. As these tests are provided to all patients this aspect of pathology will also come under strain

Consider precision medicine in NSCLC and you can start to see the problem. Pathologists now need to process sample to: send for EGFR mutation test, potentially run an IHC screen for ALK mutations, test for PD-L1 overexpression, and now run ROS1 screen

But search say the NICE TA guidance on pembrolizumab for PD-L1 and there are literally no references to pathology!