Pilot Study of Multi-Gene Pharmacogenetic Testing for Pain Management in Oncology Palliative Medicine

Patel, Jai N.; Boselli, Danielle; Symanowski, James T.; Wodarski, Stephanie; Turner, ShRhonda; Slaughter, Courtney; Myers, Melissa; Edwards, R. A.; Susi, Beth; Greiner, Rebecca; Edelen, Connie

doi:10.2217/pgs-2021-0037

Cited by 4 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36,37 While our study used a reactive approach to genotyping, some institutions are genotyping prospectively for CYP2D6 and other pharmacogenes to inform future therapies. 38,39 Indeed, our…”

Section: Lessons Learned: Clinical Implementationmentioning

confidence: 90%

See 1 more Smart Citation

CYP2D6‐guided opioid therapy for adults with cancer pain: A randomized implementation clinical trial

Mosley,

Cicali,

Del Cueto

et al. 2023

Pharmacotherapy

View full text Add to dashboard Cite

IntroductionThe CYP2D6 enzyme metabolizes opioids commonly prescribed for cancer‐related pain, and CYP2D6 polymorphisms may contribute to variability in opioid response. We evaluated the feasibility of implementing CYP2D6‐guided opioid prescribing for patients with cancer and reported pilot outcome data.MethodsAdult patients from two cancer centers were prospectively enrolled into a hybrid implementation‐effectiveness clinical trial and randomized to CYP2D6‐genotype‐guided opioid selection, with clinical recommendations, or usual care. Implementation metrics, including provider response, medication changes consistent with recommendations, and patient‐reported pain and symptom scores at baseline and up to 8 weeks, were assessed.ResultsMost (87/114, 76%) patients approached for the study agreed to participate. Of 85 patients randomized, 71% were prescribed oxycodone at baseline. The median (range) time to receive CYP2D6 test results was 10 (3–37) days; 24% of patients had physicians acknowledge genotype results in a clinic note. Among patients with CYP2D6‐genotype‐guided recommendations to change therapy (n = 11), 18% had a change congruent with recommendations. Among patients who completed baseline and follow‐up questionnaires (n = 48), there was no difference in change in mean composite pain score (−1.01 ± 2.1 vs. −0.41 ± 2.5; p = 0.19) or symptom severity at last follow‐up (3.96 ± 2.18 vs. 3.47 ± 1.78; p = 0.63) between the usual care arm (n = 26) and genotype‐guided arm (n = 22), respectively.ConclusionOur study revealed high acceptance of pharmacogenetic testing as part of a clinical trial among patients with cancer pain. However, provider response to genotype‐guided recommendations was low, impacting assessment of pain‐related outcomes. Addressing barriers to utility of pharmacogenetics results and clinical recommendations will be critical for implementation success.

show abstract

Section: Lessons Learned: Clinical Implementationmentioning

confidence: 90%

“…While our study used a reactive approach to genotyping, some institutions are genotyping prospectively for CYP2D6 and other pharmacogenes to inform future therapies 38,39 . Indeed, our physician authors reported that not having results and accompanying recommendations at the time of enrollment was a major barrier to implementation.…”

Section: Discussionmentioning

confidence: 99%

CYP2D6‐guided opioid therapy for adults with cancer pain: A randomized implementation clinical trial

Mosley,

Cicali,

Del Cueto

et al. 2023

Pharmacotherapy

View full text Add to dashboard Cite

show abstract

“…The use of PGx‐guided supportive care has been reported with opioids to help mitigate cancer‐related pain, prophylactic use of voriconazole in intermediate to high infection risk hematological malignancies, and ondansetron for chemotherapy‐induced nausea and vomiting (CINV). 19 , 20 , 21 , 22 , 23 , 24 , 25 Institutions are increasingly implementing panel‐based PGx tests to preemptively guide medications with CPIC guidelines. 26 , 27 , 28 However, utilization of a panel‐based PGx approach to specifically guide supportive care medications in patients with cancer has not been widely described.…”

Section: Introductionmentioning

confidence: 99%

“…PGx‐guided therapy could guide the use of medications most likely to be effective, thereby reducing unnecessary medical complications and financial strain, as well as improve QoL. The use of PGx‐guided supportive care has been reported with opioids to help mitigate cancer‐related pain, prophylactic use of voriconazole in intermediate to high infection risk hematological malignancies, and ondansetron for chemotherapy‐induced nausea and vomiting (CINV) 19–25 . Institutions are increasingly implementing panel‐based PGx tests to preemptively guide medications with CPIC guidelines 26–28 .…”

Section: Introductionmentioning

confidence: 99%

Implementation of a pharmacogenetic panel‐based test for pharmacotherapy‐based supportive care in an adult oncology clinic

Cicali,

Eddy,

Gong

et al. 2024

Clinical Translational Sci

View full text Add to dashboard Cite

The University of Florida Health conducted a pragmatic implementation of a pharmacogenetics (PGx) panel‐based test to guide medications used for supportive care prescribed to patients undergoing chemotherapy. The implementation was in the context of a pragmatic clinical trial for patients with non‐hematologic cancers being treated with chemotherapy. Patients were randomized to either the intervention arm or control arm and received PGx testing immediately or at the end of the study, respectively. Patients completed the MD Anderson Symptom Inventory (MDASI) to assess quality of life (QoL). A total of 150 patients received PGx testing and enrolled in the study. Clinical decision support and implementation infrastructure were developed. While the study was originally planned for 500 patients, we were underpowered in our sample of 150 patients to test differences in the patient‐reported MDASI scores. We did observed a high completion rate (92%) of the questionnaires; however, there were few medication changes (n = 6 in the intervention arm) based on PGx test results. Despite this, we learned several lessons through this pragmatic implementation of a PGx panel‐based test in an outpatient oncology setting. Most notably, patients were less willing to undergo PGx testing if the cost of the test exceeded $100. In addition, to enhance PGx implementation success, reoccurring provider education is necessary, clinical decision support needs to appear in a more conducive way to fit in with oncologists' workflow, and PGx test results need to be available earlier in treatment planning.

show abstract

Implementation and Evaluation Strategies for Pharmacogenetic Testing in Hospital Settings: A Scoping Review

Wu,

Raack,

Ross

et al. 2024

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

Background: Pharmacogenetic testing in clinical settings has improved the safety and efficacy of drug treatment. There is a growing number of studies evaluating pharmacogenetic implementation and identifying barriers and facilitators. However, no review has focused on bridging the gap between identifying barriers and facilitators of testing and the clinical strategies adopted in response. This review was conducted to understand the implementation and evaluation strategies of pharmacogenetic testing programs. Methods: A PRISMA-compliant scoping review was conducted. The included studies discussed pharmacogenetic testing programs implemented in a hospital setting. Quantitative, qualitative, and mixed design methods were included. Results: A total of 232 of the 7043 articles that described clinical pharmacogenetic programs were included. The most common specialties that described pharmacogenetic implementation were psychiatry (26%) and oncology (16%), although many studies described institutional programs implemented across multiple specialties (19%). Different specialties reported different clinical outcomes, but all reported similar program performance indicators, such as test uptake and the number of times the test recommendations were followed. There were benefits and drawbacks to delivering test results through research personnel, pharmacists, and electronic alerts, but active engagement of physicians was necessary for the incorporation of pharmacogenetic results into clinical decision making. Conclusions: Further research is required on the maintenance and sustainability of pharmacogenetic testing initiatives. These findings provide an overview of the implementation and evaluation strategies of different specialties that can be used to improve pharmacogenetic testing.

show abstract

Pilot Study of Multi-Gene Pharmacogenetic Testing for Pain Management in Oncology Palliative Medicine

Cited by 4 publications

References 17 publications

CYP2D6‐guided opioid therapy for adults with cancer pain: A randomized implementation clinical trial

CYP2D6‐guided opioid therapy for adults with cancer pain: A randomized implementation clinical trial

Implementation of a pharmacogenetic panel‐based test for pharmacotherapy‐based supportive care in an adult oncology clinic

Implementation and Evaluation Strategies for Pharmacogenetic Testing in Hospital Settings: A Scoping Review

Contact Info

Product

Resources

About