Cancer Pharmacogenomics, Adoption by Oncologists and Patient Benefit

Lynn G Dressler; Allison M Deal; Jai Patel; Janell Markey; Marcia Van Riper; Howard L McLeod

Disclosures

Personalized Medicine. 2014;11(2):143-153. 

In This Article

Abstract and Introduction

Abstract

Aim: The study aim was to understand physician experience and factors influencing the adoption of cancer pharmacogenomic (caPGx) testing by oncologists practicing in academic and nonacademic settings.

Method: Anonymous paper surveys were distributed to oncologists practicing in North Carolina (USA).

Results: Although 98% of oncologists see promise in utilizing PGx tests in their practice, few were comfortable with their knowledge (33%) or interpreting test results (37%). At one site, the survey was not distributed due to clinician unfamiliarity with the term 'pharmacogenomics'. Compared with oncologists in academia, community oncologists were more likely to order the new Oncotype Dx™ test for colon cancer (33% vs 0; p = 0.0071), more likely to indicate future use of caPGx tests (94 vs 75%; p = 0.012) and less likely to have never ordered a caPGx test (2 vs 35%%; p < 0.001). Nearly every oncologist was interested in additional PGx education.

Conclusion: A critical need exists to disseminate accurate and updated caPGx information to oncologists practicing in both academic and nonacademic settings.

Introduction

Pharmacogenomic (PGx) testing is an innovative approach to predict drug safety and effectiveness, select drug dose and exclude undue therapy.[1] In oncology, PGx utilizes the genomic information of the patient's tumor, as well as the genomic information the patient has inherited from their parents and from generation to generation to predict response to anticancer therapy. In this way, cancer PGx testing offers an approach to cancer treatment where individualized, genomic–guided decision–making, rather than trial and error, provides the potential to select the treatment or dose that may be most effective, with the least side effects at the time a patient is diagnosed with cancer. Cancer pharmacogenomics is the low–hanging fruit for implementing genomic medicine into clinical practice and has significantly changed the face of cancer care and pharmacological management of numerous types of cancer.[2] Within the last 5 years, druggable targets in lung and colorectal cancer and melanoma have revolutionized the management of these diseases, providing dramatically improved outcomes for many patients.[3–5] Although clinical application of cancer pharmacogenomics currently focuses on tumor characteristics to predict response to therapy, the patient's germline characteristics – variations that the patient has inherited – promises to provide an additional powerful resource to optimize cancer patient care.[6]

For cancer patients to benefit from these tests, however, their oncologist must first adopt the tests, be able to interpret results and find them useful in managing the care of their patient. From past experience with diffusion and uptake of innovative health technology, some clinicians will adopt these tests early, others later and some not at all.[7–10] According to diffusion theory, the decision process is influenced by a variety of factors, including clinical knowledge, familiarity and complexity of the test, attitudes about relative advantages of the test information, peer use, and channels of communication.[7,11] A previous survey of more than 10,000 physicians from a variety of disciplines and specialties reported that early adopters of PGx tests were more likely to be in an urban setting, at an intermediate stage in their careers (15–29 years in practice), and in those practicing oncology or a surgical specialty.[12] Since approximately 85% of US cancer patients are diagnosed and treated in the nonacademic setting, analyzing oncologists' perspectives and use of PGx testing in both the academic and community setting is essential.[13] In addition, exploring these issues with oncologists practicing in a largely rural state, which includes several major academic institutions, can inform a state-wide effort to optimize cancer patient management.

The purpose of this paper is to describe the results of an empirical survey study conducted with oncologists practicing in the academic and nonacademic settings in North Carolina (USA) to understand and analyze the factors that influence oncologists' adoption of cancer PGx testing to manage their cancer patients. The study is a first step in assessing whether a need exists to promote efficient dissemination of accurate cancer PGx information. Although the study was conducted with oncologists in North Carolina, findings may be applicable to other regions across the USA, especially regions with similar rurality, disparate access to cancer care and/or the presence of cancer health disparities (in particular among minority and underserved populations). This paper will also present suggestions to optimize the dissemination of cancer PGx information. To our knowledge, no other study has focused on perspectives of oncologists in the academic and nonacademic setting practicing in a largely rural state.

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