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Many physicians lack confidence interpreting genomic test results
Oncologists’ intentions to utilize multiplex genomic testing, as well as the confidence they feel interpreting test results and discussing them with patients, vary considerably, a study conducted at a tertiary-care NCI-designated comprehensive cancer center showed.
The results suggest the need for genomic screening guidelines and physician education about genomic testing, researchers wrote.
“There is significant variation in how physicians at a major cancer center plan to use multiplex tumor genomic testing in clinical practice,” researcher Stacy W. Gray, MD, AM, a medical oncologist at Dana-Farber Cancer Institute, told HemOnc Today. “Some physicians want testing for almost all of their patients and other physicians plan to test very few, if any, patients. These findings, combined with the finding that not all physicians were confident in their knowledge about genomics or ability to make treatment recommendations based on genomic data, highlight the fact that it is unlikely that this kind of test will be used in routine cancer practice in the near future.”
Gray and colleagues conducted a survey among physicians who practiced at Dana-Farber Cancer Institute/Brigham and Women’s Hospital at the initiation of Profile, an institution-wide genomic database project that utilizes a screening approach called OncoMap.
OncoMap, offered to all patients with cancer treated at Dana-Farber, screens for 471 mutations in 41 cancer-related genes. The results are categorized from tier one — which indicates high clinical utility — to tier three, which indicates the detected alterations are of uncertain significance.
The analysis by Gray and colleagues included data from 160 physicians. Participants included medical oncologists (57%), surgeons (29%) and radiation oncologists (14%). Most respondents (83%) were research principal investigators.
The majority of survey participants indicated they were “somewhat confident” with genomic testing; however, 22% reported they were “not very confident” or “not confident at all” in their knowledge of genomics. In addition, 14% of participants reported little to no confidence in their ability to explain genomic testing to patients, and 26% reported little to no confidence in their ability to determine treatment options based on genomic testing results.
Analyses controlled for potential confounders indicated participants were more likely to report high genomic confidence if they were medical oncologists (OR=4.88; 95% CI, 1.37-17.41) or researchers (OR=5.02; 95% CI, 1.28-19.69), or if they used genomic testing at baseline (OR=1.03; 95% CI, 1.00-1.05).
“While targeted tumor analysis can be extremely helpful for some cancer patients, more ‘comprehensive’ genomic testing of hundreds of cancer genes simultaneously is still largely a research activity,” Gray said.
Although Dana-Farber’s Profile project stipulates that genomic testing may be offered to all patients with cancer, 18% of participants indicated they would use genomic testing in 10% or fewer of their patients, whereas one-quarter of participants reported plans to use the testing in “most” — defined as at least 90% — of their patients. Despite this variation, 80% of participants reported the use of genomic testing would increase their professional satisfaction.
“One of the strengths of this study is that its information comes from an institution where ‘precision cancer medicine’ is available to everyone,” Barrett Rollins, MD, PhD, study co-author and chief scientific officer at Dana-Farber Cancer Institute, said in a press release. “It highlights the fact that there’s a lot of work to be done before this can be considered a standard approach in oncology.”
Participants were more likely to report plans to widely test their patients if they also reported higher genomic confidence (HR=6.09; 95% CI, 2.1-17.5). Physicians with high genomic confidence also reported intentions to recommend treatment according to tier one (OR=2.46; 95% CI, 1.2-5.2) and tier two (OR=2.89; 95% CI, 1.1-7.9) test results.
Although Dana-Farber’s policy states tier three results should not be disclosed to patients, 39% of participants indicated they “somewhat” or “strongly” disagreed with this policy, and 42% of participants reported they would disclose tier three findings.
“It will be extremely important to conduct research that explores cancer providers’ attitudes about genomic testing, their perceived barriers to test use, and their preferences for learning about new genomic technologies,” Gray said. “Without such research, we will not be able to develop effective interventions to promote the use of evidence-based genomic tests.”
The survey failed to question physicians on several relevant concerns, Michael J. Hall, MD, MS, assistant professor and director of gastrointestinal risk assessment at Fox Chase Cancer Center, wrote in an accompanying editorial. Hall outlined several of those concerns, including: “awareness of the potential barriers to patients related to costly genetic tests, what factors could affect patients’ willingness to pay out-of-pocket for expensive testing, the likelihood of identifying clinically relevant or actionable mutations, or the potential barriers to obtaining approved and experimental therapies if experimental targets are identified.”
Despite these limitations, these data further the effort to understand physicians’ opinions about the impact of genomic technologies, Hall wrote.
“These compelling findings offer an early view of academic physician perspective in the rapidly evolving world of personalized cancer medicine,” Hall wrote. “Parallel and more expansive studies conducted in regional cancer center and community-based oncology settings will provide additional insight into how powerfully next-generation sequencing technologies and multiplex genomic tests will shape the practice of oncology in the years to come.” – by Alexandra Todak
References:
Gray SW. J Clin Oncol. 2014;doi:10.1200/JCO.2013.54.8016.
Hall MJ. J Clin Oncol. 2014;doi:10.1200/JCO.2013.52.4298.
For more information:
Stacy W. Gray, MD, AM, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
Disclosure: One researcher involved with the study reports a consultant or advisory role with Merrimack Pharmaceuticals. Hall reports no relevant financial disclosures.