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Physician Attitudes About Genomic Testing

Summary and Comment |
May 20, 2014

Physician Attitudes About Genomic Testing

  1. William J. Gradishar, MD

Those with highest confidence in their genomic knowledge were most likely to order testing.

  1. William J. Gradishar, MD

An ever-growing array of genomic tools is available to clinicians to assess risk, determine prognosis, potentially define therapeutic targets, and thereby fulfill the promise of personalized therapy for cancer. But how much familiarity and comfort do physicians who care for cancer patients have with the use of these tools?

To find out, investigators surveyed 160 physicians at a major tertiary-care cancer center to assess their baseline level of genomic knowledge, current utilization of genomic testing, and likelihood of adopting this technology in patient care. The survey was conducted during the first phase of a longitudinal study (Profile), in which patients with cancer were offered OncoMap testing, which can identify 471 alterations in 41 cancer-related genes. Results of the testing would be tiered according to clinical utility: Tier-one results are genomic variants proven to be clinically relevant and potentially actionable, tier-two results are potentially actionable genomic variants, and tier-three results are of uncertain relevance. Only tier-one and tier-two results were to be shared with patients, whereas tier-three results were not to be shared.

A total of 160 physicians responded (61%), the majority being medical oncologists (57%), followed by surgeons (29%) and radiation oncologists (14%). Of the total, 22% reported low confidence in their genomic knowledge, 18% indicated that they were likely to use genomic testing infrequently (for ≤10% of patients), and 25% indicated that they would use it frequently (for ≥90% of patients). Predictably, physicians with the highest confidence in genomic knowledge were most likely to order testing. Of note, 42% of physicians disagreed with the decision to prohibit the sharing of tier-three results with patients.

Comment

These results highlight the challenges that clinicians will face as testing becomes more widely used and as patients become more aware of its availability. Even at a premier, tertiary-care and research institution, clinicians' understanding of genomic testing varied greatly as did their comfort in ordering it. Furthermore, whether the knowledge gained from the results is clinically actionable and whether all information should be shared with patients remain debatable. Clearly, a major educational effort will be required by cancer clinicians to attain uniform minimal knowledge regarding genomic testing.

  • Disclosures for William J. Gradishar, MD at time of publication Consultant / Advisory board Biologics, Inc. Editorial boards Clinical Breast Cancer; Journal of Clinical Oncology; Oncology Leadership positions in professional societies American Society of Clinical Oncology (Nominating Committee Chair)

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