Physicians' Attitudes About Multiplex Tumor Genomic Testing

Abstract

Physicians at a tertiary-care National Cancer Institute-designated comprehensive cancer center varied considerably in how they planned to incorporate predictive multiplex somatic genomic tests into practice and in their attitudes about the disclosure of genomic information of uncertain significance. Given that many physicians reported low genomic confidence, evidence-based guidelines and enhanced physician genomic education efforts may be needed to ensure that genomically guided cancer care is adequately delivered.

Institutional implementation of clinical tumor profiling on an unselected cancer population

“…While encouraging, the proportion of patients that actually have this information used for clinical management remains much lower, in the 5%-10% range. There are a multitude of reasons for this, ranging from patient preferences (20) and physician comfort with genomic data (22), to biologically relevant information, such as time of testing in the course of a patient's disease, availability of clinical trials, and cost of off-label use of drugs. Despite these barriers, there is evidence to support the clinical utility of molecularly targeted therapy in specific indications (4,21,24,25), though heavily pretreated patients may not benefit to the same degree (25).…”

“…A variety of logistic, operational, and medical reasons (20) have been cited, such as identification of the appropriate genomic target at the right time in a patient's clinical course, time to result, the value of biopsy at the time of progressive disease (21), choice of conventional treatment protocols, access to clinical trials (16,20) or off-label use of drug (19), and patient preferences (20). Similarly, evaluation of the confidence of physicians at our institutions in using genomic data to make decisions on patient treatment options (22) indicates that not all "actionable" genomic data will be acted upon.…”

Section I: Integrating laboratory medicine with tissue specimens

“…A recent survey of medical oncologists, radiation oncologists, and surgical oncologists performed by Gray et al 55 highlighted that approximately 20%-25% of participants were not very confident or not confident at all in their knowledge of complex genomics, their ability to explain complex genomic concepts to patients, or their ability to make treatment recommendations based on complex genomic data. An "unfamiliarity" with genetic information is not unique to cancer and has been recognized as an area that requires education in both medical curricula and everyday practice.…”

The next steps in next-gen sequencing of cancer genomes

“…Genomic confidence and genomic navigators. The survey by Gray and colleagues suggests that even in tertiary care centers, many physicians do not feel confident about their knowledge of genomics (61). While not directly surveyed, this low genomic confidence would suggest a relative reticence toward both ordering next-gen sequencing of cancer genomes as well as discussing their implications directly with patients.…”

“…It is undeniable that the next-gen sequencing of cancer genomes has become widespread as well as commercialized (e.g., FoundationOne), suggesting that physicians have confidence in the technology and process as well as comfort in discussing genomic results with their patients. A survey of physicians at a tertiary care center prior to the rollout of their next-gen tumor-sequencing platform, however, revealed that there was a wide variability in how physicians planned to incorporate potential results into clinical practice and in their attitudes toward the disclosure of variants of undetermined significance (61). As might be expected, physician opinion on these topics correlated with their driven oncology, likely holds a multiplatform approach that will allow comprehensive characterization of a tumor on multiple levels; the resulting genomic profile would then be integrated with other "omic" data to predict the functional consequences of genomic alterations on oncogenic pathways.…”