Study Finds Oncologists Have Mixed Attitudes on the Use of Genomic Testing
While many cancer researchers believe that predictive somatic genomic testing holds the potential to usher in the era of precision medicine for patients with cancer, research by Gray et al suggests that not all physicians are eager to embrace the technology. The variation in attitudes was in part determined by the physicians’ level of confidence in their ability to use and explain genomic findings to their patients. The study is published in the Journal of Clinical Oncology.
Researchers from Dana-Farber Cancer Institute surveyed physicians from Dana-Farber/Brigham and Women’s Cancer Center, which has a comprehensive research program that allows all consenting patients to have their tumor genomically tested for mutations and other DNA changes that drive their cancer. A total of 160 physicians participated in the online survey (response rate, 61%): 57% were medical oncologists, 29% were surgeons, and 14% were radiation oncologists.
The physicians were asked about their current use of somatic testing, their attitudes about multiplex testing, and their confidence in their ability to understand and use genomic data. The study did not, however, include a direct test of the physicians’ knowledge of genomic testing.
The survey was conducted between 2011 and 2012 as a baseline assessment of physicians’ attitudes prior to the launch of a tumor-profiling research study at Dana-Farber/Brigham and Women’s Cancer Center called Profile.
Study Findings
Twenty-two percent of physicians reported low confidence in their genomic knowledge, 18% of physicians anticipated testing patients infrequently (≤ 10%), and 25% anticipated testing most patients (≥ 90%). Higher genomic confidence was associated with wanting to test a majority of patients (adjusted odds ratio [OR] = 6.09; 95% confidence interval [CI] = 2.1–17.5) and anticipating using actionable (adjusted OR = 2.46; 95% CI = 1.2–5.2) or potentially actionable (adjusted OR = 2.89; 95% CI = 1.1–7.9) test results to inform treatment recommendations. In addition, 42% of respondents said they approved disclosing uncertain genomic findings to patients.
Call for Renewed Efforts in Genomic Education
“Some oncologists said we shouldn’t return these results to patients, and others say ‘of course, we should give them to the patient,’” Stacy W. Gray, MD, AM, first author of the study and a thoracic cancer physician at Dana-Farber, said in a statement. “The fact that we found so much variation in physicians’ confidence about their ability to use genetic data at a tertiary care National Cancer Institute–designated comprehensive cancer center makes us pause and wonder about how confident physicians in the community are about dealing with this. It begs the question at the national level, how are we going to make sure that this technology for cancer care is adequately delivered?”
“These data suggest the value of evidence-based guidelines to help physicians determine when genomic testing is indicated and renewed efforts in physician genomic education and decision support,” concluded the researchers. “Finally, a concerted effort is needed to ensure that physicians present information about predictive multiplex tests to patients in a way that enhances patient understanding and increases patients’ test acceptance. It is only through further study and a nuanced understanding of the physician-related factors that contribute to variations in genomic cancer care that we will be able to design and implement interventions promoting the appropriate adoption of these innovative technologies.”
Dr. Gray is the corresponding author for the Journal of Clinical Oncology article.
An accompanying editorial was written by Michael J. Hall, MD, of Fox Chase Cancer Center, Philadelphia, PA.
Funding for this study was supported by the Dana-Farber Cancer Institute. Dr. Gray receives support from the American Cancer Society and the National Human Genome Research Institute.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
