ACCESS, OUTCOMES, AND ECONOMIC PERSPECTIVES IN PRECISION ONCOLOGY: REAL-WORLD EVIDENCE ON BIOMARKER TESTING AND TARGETED THERAPY FROM THE NIH ALL OF US PROGRAM

This manuscript‑based dissertation brings together three peer‑reviewed studies at the intersection of precision oncology, health equity, and cancer education, leveraging real‑world data (RWD) from the NIH All of Us Research Program.The All of Us Research Program is a large, national cohort designed to reflect the diversity of the United States population and integrates electronic health record (EHR) data, survey responses, and biospecimen information, making it well suited to examine equity, documentation, and access to precision oncology in routine clinical care.Chapter 1 provides an overview of precision oncology implementation, cancer education, and health equity, and outlines the conceptual framework linking social determinants of health (SDoH), biomarker testing, and treatment access.Chapter 2 (manuscript 1) examines national patterns of documented biomarker testing across colorectal (CRC), non–small cell lung (NSCLC), and prostate cancers and evaluates associations with social determinants of health (SDoH). Among 11,415 patients, only 2.4% had documented testing (71% panel‑based); unemployment and college education were associated with higher odds of testing in the combined model, with cancer‑specific differences that underscore heterogeneity in access and documentation. These findings reflect both under-documentation and gaps in structured electronic health records (EHRs), rather than true clinical utilization.Chapter 3 (manuscript 2) focuses on advanced NSCLC and the educational and equity implications of biomarker testing and targeted therapy access. In a cohort of 287 first‑line treated patients, documented biomarker testing was