Oncologists Show Low Genomic Confidence about the Use of Genetic Testing

Laura Morgan

September 2014, Vol 5, No 7 - Personalized Medicine


Predictive multiplex genomic (or genetic) testing may revolutionize the treatment of cancer by identifying targetable mutations in cancer genes for their individual patients. Although genetic testing is commercially available, its use in clinical practice has not been fully investigated.

A team of researchers recently conducted a survey to assess oncologists’ current knowledge and use of genomic testing, their attitudes about multiplex genomic testing, and their genomic confidence (Gray SW, et al. J Clin Oncol. 2014;32:1317-1323). The survey included 160 oncologists at Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, and was conducted before the institution of the multiplex genomic testing at this major cancer institute, as part of the Profile research study that analyzes DNA from tumor tissues to provide meaningful results to patients.

“When we find alterations in patients’ tumors, and when we are able to match those alterations with targeted cancer therapy, the improvement in the quality of patients’ lives, and sometimes the length of their lives, is dramatic,” lead researcher Stacy W. Gray, MD, AM, Department of Medical Oncology, Dana-Farber Cancer Institute, told Value-Based Cancer Care.

“I see what a difference these medications can make, and I feel very strongly that we have to try to help as many people as possible who may benefit from genetic testing and targeted therapies,” Dr Gray pointed out.

A total of 160 oncologists at the cancer institute completed the survey, which examined physicians’ genomic confidence and asked them:

  • To estimate the percentage of patients for whom they would want genomic testing
  • How often they would disclose the results to patients
  • How often they would use results to inform treatment recommendations
  • The terms they would use to describe genomic testing to patients
Where would they seek information to learn more about the test results.

Oncologists’ Genomic Confidence
The results showed that many oncologists lacked genomic confidence. Specifically:

  • 22% of the survey participants were not very or not at all confident in their knowledge of genomics
  • 14% lacked confidence in their ability to explain genomic concepts to patients
  • 26% lacked confidence in their ability to make treatment recommendations based on genomic data.

Based on a conversation with Dr Gray, continuing education in the area of genetics is crucial for oncologists. “I think that one of the major challenges of the delivery of personalized cancer care is the fact that our understanding of cancer genetics, and our understanding of the complex pathways that are in patients’ tumors changes almost on a day-to-day basis,” Dr Gray explained.

“Genetics has been a very small part of medical school curricula until very recently, and, even now, it does not play a major role in most medical schools’ curriculum. And so I think that because the field changes so quickly and because a lot of people need to learn on the job, continuing medical education is essential,” she pointed out.

Current and Future Use of Genetic Testing
When asked about the future use of multiplex genetic testing, 18% of oncologists anticipated testing patients infrequently (?10% of patients), and 25% anticipated testing most patients (?90%). Some factors involved in oncologists’ decisions on whether to use genomic testing include the stage of the disease, patient characteristics (eg, age), and genetic status.

Overall, 73% of participating oncologists reported that genetic testing would increase their patients’ treatment options, prognostic information, and satisfaction; the time required to discuss treatment options; as well as research opportunities. The oncologists’ genomic confidence was one of the strongest predictors of their anticipation of using this type of testing for their patients.

Disclosure of Genetic Findings to Patients
The findings showed that nearly 23% of oncologists rarely or only sometimes would disclose tier-1 results. This was a surprising finding, because tier-1 results are clinically relevant, and the researchers expected that only a small percentage of oncologists would not disclose tier-1 results to their patients.

The researchers attributed the high percentage of nondisclosures to lower genomic confidence among the oncologists and to lower baseline genetic testing. For example, the oncologists with higher genomic confidence were more likely to report tier-1 and tier-2 results.

In addition, more than 40% of oncologists believed in the disclosure of uncertain genetic findings, and 39% disagreed with the policy of prohibiting the return of tier-3 results. Again, higher genomic confidence played a role in oncologists’ wishing to disclose tier-3 results to their patients.