Physicians' attitudes about multiplex tumor genomic testing

Abstract

Purpose: Although predictive multiplex somatic genomic tests hold the potential to transform care by identifying targetable alterations in multiple cancer genes, little is known about how physicians will use such tests in practice.

Participants and methods: Before the initiation of enterprise-wide multiplex testing at a major cancer center, we surveyed all clinically active adult cancer physicians to assess their current use of somatic testing, their attitudes about multiplex testing, and their genomic confidence.

Results: A total of 160 physicians participated (response rate, 61%): 57% were medical oncologists; 29%, surgeons; 14% radiation oncologists; 37%, women; and 83%, research principal investigators. Twenty-two percent of physicians reported low confidence in their genomic knowledge. Eighteen percent of physicians anticipated testing patients infrequently (≤ 10%), whereas 25% anticipate testing most patients (≥ 90%). Higher genomic confidence was associated with wanting to test a majority of patients (adjusted odds ratio [OR], 6.09; 95% CI, 2.1 to 17.5) and anticipating using actionable (adjusted OR, 2.46; 95% CI, 1.2 to 5.2) or potentially actionable (adjusted OR, 2.89; 95% CI, 1.1 to 7.9) test results to inform treatment recommendations. Forty-two percent of physicians endorsed disclosure of uncertain genomic findings to patients.

Conclusion: 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.

Fig 1.

Physicians' genomic confidence.

Fig 2.

Percent of patients for whom physicians anticipated wanting OncoMap testing.

Fig 3.

Percentage of physicians who believed that (A) genomic alterations and (B) wild-type results should be discussed with patients (by tier).

Fig A1.

Percentage of physicians who intended to view OncoMap test results.

Fig A2.

Percentage of physicians who intended to (A) disclose OncoMap test results and (B) use OncoMap test results to inform treatment recommendations (by tier).

Fig A3.

Physicians' agreement with institutional policy to prohibit return of tier-three results to patients.