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Integrating next‐generation sequencing into pediatric oncology practice: An assessment of physician confidence and understanding of clinical genomics
Author(s) -
Johnson LizaMarie,
Valdez Jessica M.,
Quinn Emily A.,
Sykes April D.,
McGee Rose B.,
Nuccio Regina,
HinesDowell Stacy J.,
Baker Justin N.,
Kesserwan Chimene,
Nichols Kim E.,
Mandrell Belinda N.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30581
Subject(s) - germline , medicine , genetic testing , germline mutation , test (biology) , confidence interval , genetic counseling , oncology , precision medicine , genomics , cancer , family medicine , genetics , mutation , genome , pathology , biology , paleontology , gene
BACKGROUND The incorporation of genomic testing to identify targetable somatic alterations and predisposing germline mutations into the clinical setting is becoming increasingly more common. Despite its potential usefulness, to the authors' knowledge physician confidence with regard to understanding and applying genomic testing remains unclear, particularly within the realm of pediatric oncology. METHODS Before initiating an institutional feasibility study regarding the integration of clinical genomic testing, the authors surveyed pediatric oncologists regarding their confidence around understanding of genomic testing, perceived usefulness of test results, preferences around the disclosure of germline test results, and possible risks and benefits of testing. RESULTS Among survey respondents (52 of 88 contacted; response rate of 59%), only a minority were confident in interpreting, using, and discussing somatic (35%) or germline (27%) genomic test results. Providers who were confident in interpreting somatic results were significantly more likely to anticipate using the results to plan the treatment of patients with relapsed or refractory cancers ( P = .009). Similarly, providers who reported confidence in interpreting germline results were significantly more likely to discuss and use these results as part of clinical care ( P <.0001). The majority of physicians (93%), regardless of their level of confidence, wanted to speak to a genetic counselor before disclosing germline test results. CONCLUSIONS Among physicians at a comprehensive pediatric cancer center, confidence in the interpretation, use, and discussion of oncology‐based genomic test results appears to be low, both in terms of somatic and germline testing. To optimize the integration of genomic sequencing into cancer care, methods must be developed to improve basic competencies around cancer‐based genomic testing. Given the complexities surrounding variant interpretation and genotype‐phenotype relationships, interdisciplinary collaborations are warranted. Cancer 2017;123:2352–2359. © 2017 American Cancer Society .