Advancing equity in precision oncology: Impact of in-house NGS for NSCLC in a safety-net hospital.

e20704 Background: Next-generation sequencing (NGS) is essential for NSCLC management, yet access remains inequitable. We evaluated in-house NGS at New England’s largest safety-net hospital, where 65% of patients identify as racial or ethnic minorities, to assess its impact on uptake, turnaround time, test failure, and time to treatment. Methods: We conducted a retrospective study of adults with stage II–IV NSCLC treated at Boston Medical Center from 01/2019–01/2024 (n = 277). In-house NGS was implemented on 10/01/2022. Patients were classified as receiving in-house NGS, send-out NGS (external laboratories such as Foundation or Guardant), limited molecular testing (e.g., FISH, PCR), or no testing. Outcomes included NGS uptake, turnaround time, time to treatment, and testing failure. Interrupted time series evaluated changes in uptake, and multivariable regression identified factors associated with NGS receipt. Results: The cohort was 59.2% non-White, 10.8% Hispanic, 26.0% non–English-speaking, and 61% insured by Medicaid or Medicare; 44% lived in the most socioeconomically deprived neighborhoods per Area Deprivation Index. Overall, 147 patients (53.1%) received tissue-based NGS. NGS use was increasing before in-house implementation, with no discrete change in uptake attributable to implementation. Importantly, NGS receipt was comparable across race, ethnicity, insurance status, and primary language groups. Among patients receiving tissue-NGS, in-house testing shortened turnaround time (17 vs 22 days, p = 0.0005) and time to treatment (30 vs 42 days, p = 0.015) compared with send-out testing. Testing failure was lower with in-house NGS (15.3% vs 25.3%), though not statistically significant. First-line targeted therapy was more common after solid-tumor NGS (21.8%) than after limited or no testing (5.7%). Conclusions: In a diverse safety-net population, in-house NGS significantly reduced turnaround time and expedited treatment initiation, with higher use of targeted therapy. Although differences in testing failure rates did not reach statistical significance, likely due to limited power, failures were less frequent with in-house NGS, potentially reflecting closer integration with in-house pathology. Together, these findings support in-house NGS as an effective strategy to improve access to timely molecular testing in resource-limited settings. These findings support in-house NGS as a practical strategy to enhance access to timely precision oncology in resource-limited settings.