Survey of Australian Oncologists Finds Room for Increasing Their Confidence With CGP

With the explosion of comprehensive genomic profiling (CGP) comes increased responsibilities for oncologists, who must discuss implications of testing and translate complex findings to patients. A recent survey of oncologists in Australia showed that while most are integrating CGP into their practice, they lack a high level of confidence to communicate findings and to adjust patient treatment accordingly.

CGP is a rapidly growing, complex field where gene panels containing hundreds of genes in a single assay can detect genomic alterations that fuel cancer. CGP can also reveal secondary germline findings, identifying variants for cancer susceptibility.

A report released last year examining confidence among oncologists in the United States found that most were confident with single-gene tests but less so with more advanced testing; confidence was also correlated with training and among physicians working in highly-resourced academic centers and specialized cancer centers.

The authors, writing in Oncotarget, said that while there exists a framework for communicating genomic research results in Australia, how the guidance has affected real-world clinical practice is unknown.

In July 2018, the Medical Oncology Group of Australia sent an email to its membership (n = 333); from August 2018 to January 2019, follow-up emails were sent to oncologists who had referred patients to the Molecular Screening and Therapeutics (MoST) Program, which recruits adult patients with advanced or metastatic solid cancers.

In total, 33%, or 108 oncologists, completed the survey. Findings showed 90% (n = 97, 90%) had referred patients for CGP.

Using a 100-point visual analogue scale score (VAS), with higher values showing greater confidence, most oncologists were confident gaining consent from patients for CGP referral (median VAS, 75; [interquartile range] IQR, 53-85), and discussing CGP results (median VAS, 70; IQR, 51-80).

Confidence with pursuing therapies based on CGP findings increased with clinical experience. However, most providers wanted help interpreting the results as well as access to resources to aid patient communication.

The majority of oncologists also had prerequisites for referring patients for CGP, including adequate life expectancy, organ function, and Eastern Cooperative Oncology Group performance status. In addition, 21% said "they would initiate CGP only to access therapy with reasonable efficacy in the relevant context, in the absence of standard treatment options or where significant comorbidities precluded standard treatment, and where the patient had a full understanding of the potential financial implications."

In regards to next steps to take with patients, some oncologists did not want recommendations to an inaccessible treatment, including international clinical trials. Less than half (46%) sought only clinically actionable variants, 36.1% wanted all genetic variants, 18.5% reported seeking only "therapeutically actionable" variants.

The study had a limitation in that many of the participating oncologists came from the MoST program for CGP, and therefore may not be representative of medical oncologists as a whole, so findings may be overestimated.

Reference

Thavaneswaran S, Ballinger M, Butow P, et al. The experiences and needs of Australian medical oncologists in integrating comprehensive genomic profiling into clinical care: A nation-wide survey. Oncotarget. Published online October 12, 2021. doi: 10.18632/oncotarget.28076