Oncologist Confidence in Genomic Testing and Implications for Using Multimarker Tumor Panel Tests in Practice
Oncologist Confidence in Genomic Testing and Implications for Using Multimarker Tumor Panel Tests in Practice
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DOI：
10.1200/po.19.00338
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发表时间：
2020-06-11
影响因子：
4.6
通讯作者：
Freedman, Andrew N.
中科院分区：
文献类型：
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作者：
de Moor, Janet S.;Gray, Stacy W.;Freedman, Andrew N.
精准肿瘤学的发展越来越要求肿瘤学家将基因组检测纳入实践。然而，提供者对基因组检测的信心缺乏记录。这篇文章描述了医学肿瘤学家对基因组检测的信心以及基因组信心和检测使用之间的关联。METHODS我们使用了2017年全国癌症治疗精准医学调查的数据来描述肿瘤学家对基因组检测的信心。按测试用户类型分别检查基因组置信度：仅下一代测序（NGS），仅基因表达（GE），NGS和GE，或非用户。基因组置信度的预测因子用多项逻辑回归进行检验。基因组置信度和检测使用之间的关联用多变量线性回归进行检查。超过75%的基因组检测使用者对使用多标记物肿瘤面板检测的结果指导患者护理有中等或非常自信。NGS和GE测试用户使用多标记物肿瘤面板测试的信心最高，60.1%对使用测试结果非常有信心，仅NGS测试用户的信心最低，38.2%对使用测试结果非常有信心。肿瘤学家对使用单基因检测最有信心，对使用全基因组或外显子组测序指导患者护理最不自信。基因组的信心与自我报告的测试使用呈正相关。在调整后的模型中，基因组学培训，更大的患者数量和治疗实体瘤患者预测了更高的基因组置信度。现场病理服务和接收电子病历警报基因组检测预测较低的genomic confidence.CONCLUSIONOncologists的信心不同的测试平台，病人的数量，基因组培训，和实践基础设施。需要进行研究，以确定可以有针对性地提高提供者对基因组检测的信心的可修改因素。
PURPOSEThe evolution of precision oncology increasingly requires oncologists to incorporate genomic testing into practice. Yet, providers' confidence with genomic testing is poorly documented. This article describes medical oncologists' confidence with genomic testing and the association between genomic confidence and test use.METHODSWe used data from the 2017 National Survey of Precision Medicine in Cancer Treatment to characterize oncologists' confidence with genomic testing. Genomic confidence was examined separately by type of test user: next-generation sequencing (NGS) only, gene expression (GE) only, both NGS and GE, or nonuser. Predictors of genomic confidence were examined with multinomial logistic regression. The association between genomic confidence and test use was examined with multivariable linear regression.RESULTSMore than 75% of genomic test users were either moderately or very confident about using results from multimarker tumor panel tests to guide patient care. Confidence with using multimarker tumor panel tests was highest among both NGS and GE test users, with 60.1% very confident in using test results, and lowest among NGS-only test users, with 38.2% very confident in using test results. Oncologists were most confident in using single-gene tests and least confident in using whole-genome or -exome sequencing to guide patient care. Genomic confidence was positively associated with self-reported test use. In adjusted models, training in genomics, larger patient volume, and treating patients with solid tumors predicted higher genomic confidence. Onsite pathology services and receipt of electronic medical record alerts for genomic testing predicted lower genomic confidence.CONCLUSIONOncologists' confidence varies by testing platform, patient volume, genomic training, and practice infrastructure. Research is needed to identify modifiable factors that can be targeted to enhance provider confidence with genomic testing.