The survey was done in 2011 and early 2012 as a baseline assessment of physicians' attitudes prior to the rollout of the tumor profiling project called Profile at DF/BWCC. The Profile technology platform includes complete DNA sequencing of more than 300 genomic regions to detect known and unknown cancer-related mutations. The technology can also examine those regions for gains and losses of DNA sequences and rearrangements of DNA on chromosomes. The results are entered into a database for research purposes, but, if patients agree, the clinically important findings can also be returned to their doctor for use in the clinic.
A total of 160 adult cancer physicians – including medical oncologists, surgeons and radiation oncologists – participated in the survey. They were asked about their current use of somatic testing (i.e., testing patients' tumors for known mutations one at a time), their attitudes about multiplex testing, and their confidence in their ability to understand and use genomic data. The survey did not include a direct test of the physicians' knowledge.
Respondents said they ordered tumor genomic testing on an average of 24 percent of patients. Twenty-two percent of the doctors reported low confidence in their knowledge about genomics. Fourteen percent lacked knowledge in explaining these concepts to patients, and 26 percent doubted their ability to make treatment recommendations based on genomic data. Perhaps for these reasons, 18 percent of the physicians said they planned to use multiplex tumor testing only infrequently.
Gray and her colleagues conclude there is "little consensus" on how physicians plan to use this new tool for personalized cancer care, and suggest the need for evidence-based guidelines to help doctors determine when testing is indicated.
"One of the strengths of this study is that its information comes from an institution where 'precision cancer medicine' is available to everyone," commented Barrett Rollins, MD, PhD, a co-author on the paper and Dana-Farber's Chief Scientific Officer. "It highlights the fact that there's a lot of work to be done before this can be considered a standard approach in oncology."
The senior author is Jane Weeks, MD, MSc, of Dana-Farber; other authors are Angel Cronin, MS, of Dana-Farber and Katherine Hicks-Courant, BA, of the University of Massachusetts Medical School.