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Genomic Confidence

Some oncologists are rather gung-ho about using multiplex genomic tests and ready to use them to evaluate tumors and develop treatments for most of their patients, but others are much more wary about these gadgets, a new study finds.

The survey results, published in the Journal of Clinical Oncology, suggests there is "wide variation" in attitudes among cancer doctors about using multiplex tests to hunt for hundreds of variations in tumors.

Their opinions varied on how they would use these predictive tests in their practices and in how they feel about disclosing genomic information that is of unknown significance.

According to first author Stacy Gray, of Dana-Farber Cancer Institute, the differences between oncologists who are prepared to use multiplex tests and those who are more skeptical about them may boil down to their "genomic confidence."

Physicians who think they know how to use and explain genomic test findings were likely to prescribe a test and consider using test results in making their treatment recommendations, while physicians with lower levels of genomic confidence were reluctant to offer multiplex tests.

The survey of 160 cancer physicians found that tumor genomic testing was ordered for an average of 24 percent of patients. Twenty-two percent of these doctors reported having low confidence in their knowledge of genomics, 14 percent said they lacked the knowledge to explain these concepts to patients, and 26 percent doubted their ability to make treatment recommendations based on genomic data.

An interesting tidbit about the findings… the study surveyed physicians at the Dana Farber/Brigham and Women's Cancer Center, which has a research program in place that allows all consenting patients to have tumor testing for mutations that could be used to develop their treatment plans.

"Some oncologists said we shouldn’t return these results to the patient, and others say ‘of course we should give them to the patient," Gray says.

She thinks that the fact that so much variation in opinions was found among physicians at an NCI-designated Comprehensive Cancer Center should give reason to "pause and wonder about how confident physicians in the community are about dealing with this."

"It begs the question at a national level, how are we going to make sure that this technology for cancer care is adequately delivered?"