Physicians' Attitudes About Multiplex Tumor Genomic Testing
Physicians' Attitudes About Multiplex Tumor Genomic Testing
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DOI：
10.1200/jco.2013.52.4298
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发表时间：
2014-05-01
影响因子：
45.3
通讯作者：
Weeks, Jane C.
中科院分区：
文献类型：
--
作者：
Gray, Stacy W.;Hicks-Courant, Katherine;Weeks, Jane C.
目的虽然预测性多重体细胞基因组测试有可能通过识别多个癌症基因中的靶向改变来改变护理，但人们对医生在实践中如何使用此类测试知之甚少。参与者和方法在一家主要癌症中心启动企业范围内的多重测试之前，我们调查了所有临床活跃的成年癌症医生，以评估他们目前对体细胞测试的使用情况、他们对多重测试的态度以及他们的基因组信心。结果共有 160 名医生参与（响应率、 61%)：57%是肿瘤内科医师； 29%，外科医生； 14% 放射肿瘤科医生； 37%，女性； 83% 是研究主要研究者。 22% 的医生表示对自己的基因组知识缺乏信心。 18% 的医生预计不会经常对患者进行检测 (= 90%)。较高的基因组置信度与想要测试大多数患者（调整后的比值比 [OR]，6.09；95% CI，2.1 至 17.5）并预期使用可操作（调整后的 OR，2.46；95% CI，1.2 至 5.2）或潜在可操作（调整后的 OR，2.89；95% CI，1.1 至 7.9）测试结果来指导治疗相关。建议。 42% 的医生赞同向患者披露不确定的基因组发现结果。 结论 美国国家癌症研究所指定的三级综合癌症中心的医生们在计划如何将预测性多重体细胞基因组测试纳入实践以及对披露意义不确定的基因组信息的态度方面存在很大差异。鉴于许多医生报告基因组信心较低，可能需要基于证据的指南和加强医生基因组教育工作，以确保充分提供基因组指导的癌症护理。
PurposeAlthough 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 MethodsBefore 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.ResultsA 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 (= 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.ConclusionPhysicians 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.