Overview
We spoke to a senior pathologist at a New England hospital on June 16 and came away from the discussion with more conviction that the return to "normal" is happening and there's an acuity aspect of it that's going to be hard to measure. All the anecdotes suggest that the deferral of care last year - the 1+ billion missed diagnoses IQV talks about - has led to an increase in later-stage disease for clinicians to deal with this year. Cancer testing - everything from flow cytometry and IHC to NGS - is up and tracking ahead of pre-COVID-19 levels. We'll continue to follow up on this trend with industry contacts and via our data (claims, etc.), and if you know anyone we should check with/speak to or have questions, please email us - .
Call Notes / Highlights
Seeing a "tremendous amount of cancer" - agrees with deferred care thesis impact, colonoscopies are definitely backlogged.
YTD, it feels like volumes up a lot, and looking at accessions for biopsies and other surgical resections, it's not just cancer - the data for all specimens coming through the lab on the pathology side, pre-COVID vs. now, are about two weeks ahead (i.e., the accessioning numbers weren't seen for another two weeks in 2019). "That's big for a pathology practice."
- Usually, annual growth, we're talking maybe a few days or a week ahead. but to be two weeks ahead of pre-COVID is big, translates from there to esoteric lab companies.
- Regarding cancers - activity around breast cancer feels like it has exploded (more mastectomies. larger tumors + advanced disease, shift toward radical surgeries - feels like younger women are getting a diagnosis and want to be done with it - not deal with relapse, residual disease, etc. - prophylactic up too).
- Colon cancer is up too - three surgeons actively operating, more cancer diagnoses now.
- Feels like lung nodules being followed in the clinic by CT up as well.
There's likely still a gap to make up = will continue to be busy for the remainder of the year. He hasn't seen a normal summer slowdown - on the contrary, there's talk of extra operating rooms and managing surgeon vacation time (staff like non-summer), operating later in the day.
With more cancer diagnoses, more cases going to Genomic Health (Oncotype for breast is frequently ordered, prostate too).
Blood cancers are up ("skyrocketed") - NeoGenomics (NEO) gets a lot of that flow - lymphoma, leukemia, bone marrow, lymph and blood - bone marrow sage 4, leukemia, MDs need to understand why counts are low - bone marrow biopsy, send for flow cytometry, molecular, FISH - PCR, NGS too.
- More lymphoma - higher grade - and myeloma more so than pre-COVID.
A lot of esoteric goes to Mayo (reference lab) - like others, there's a push to insource, but there's a lot of testing w/ out the volume to support in-house (cost of instrumentation, run QC, manpower, etc.). Each of our sites has its own reference labs/resources - we send heme to NEO, another community hospital might use Mayo, etc. Why? Generally speaking, hospitals can look at the top tests they send out, cost, and see if it makes sense to do internally - if so, can save $100s-of-thousands.
What do you like about NEO?
They are very, very user-friendly. Great dashboard, NEO Link Login, we see the status of cases, can add on testing easily, they'll fax, but also go on frequently. It's unique to have such a user-friendly website, and they have good turnaround times.
Remarkable to have something drawn today and have the result tomorrow afternoon, or definitely by the next day (combination of FedEx, commercial). There is a risk - cost utilization, new care models, etc. lead to more insourcing; right now, definitely a benefit from the rise in cancer diagnoses.
Also, NEO reports are good but could benefit from better standardization, each pathologist may sign out differently. Mayo's are very structured, might get a different flavor w/ NEO.
Our oncologists like Guardant (GH) a lot - that testing doesn't go through the lab though - it's straight from the offices. I advocate for getting pathologists involved, overutilization, misutilization, but for now. Liquid biopsy might be overutilized a bit; however, Guardant360 is popular.
- Sounds like use for treatment selection is up.
We use Foundation frequently, some prefer Foundation vs. internal - gene coverage opinions. which are better, but detractor - pride about comprehensive report (40+ pages), link to trials, report, order things, the report is huge.
Another name gaining traction - hearing more Caris.
There's a lot more NGS going on, and I think liquid biopsy continues to grow - there's a lower trigger to doing it. GI cancers, see almost every pancreatic out for NGS; lung, only advanced. despite ALK, EGFR, KRAS, not everything gets sequenced. Room for growth. Breast doesn't get sequenced as much - ERPR/HER2 - IHC in-house.
Do you have a view on Grail or Thrive, Human Longevity?
It all seems niche. It may not even come through a lab, just not sure, yet.
Thoughts on MRD or do you see Natera's Signatera at all?
I'm seeing more requests for material to send out - more so than pre-COVID, and we just got a delivery with a whole bunch of marketing. They've put on a full-court press. Reps are coming into the office, but they're getting the message across and we're seeing requests for Singatera come through for different cancer types (not just CRC).
Please reach out to with feedback or inquiries.
Thomas Tobin
Managing Director
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