Medical oncologists' experiences in using genomic testing for lung and colorectal cancer care

Stacy W. Gray, Benjamin Kim, Lynette Sholl, Angel Cronin, Aparna R. Parikh, Carrie N. Klabunde, Katherine L. Kahn, David Haggstrom, Nancy L. Keating

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Purpose Genomic testing improves outcomes for many at-risk individuals and patients with cancer; however, little is known about how genomic testing for non-small-cell lung cancer (NSCLC) and colorectal cancer (CRC) is used in clinical practice. Patients and Methods In 2012 to 2013,wesurveyed medical oncologists whocare for patients in diverse practice and health care settings across the United States about their use of guideline-And non-guideline-endorsed genetic tests. Multivariable regression models identified factors that are associated with greater test use. Results Of oncologists, 337 completed the survey (participation rate, 53%). Oncologists reported higher use of guideline-endorsed tests (eg, KRAS for CRC; EGFR for NSCLC) than non-guideline-endorsed tests (eg, OncotypeDX Colon; ERCC1 for NSCLC).Many oncologists reported having no patients with CRC who had mismatch repair and/or microsatellite instability (24%) or germline Lynch syndrome (32%) testing, and no patients with NSCLCwho had ALK testing (11%).Of oncologists, 32% reported that five or fewer patients had KRAS and EGFR testing for CRC and NSCLC, respectively. Oncologists, rather than pathologists or surgeons, ordered the vast majority of tests. In multivariable analyses, fewer patients in nonprofit integrated health care delivery systems underwent testing than did patients in hospital or office-based single-specialty group settings (all P,.05).High patient volume and patient requests (CRC only) were also associated with higher test use (all P , .05). Conclusion Genomic test use for CRC and NSCLC varies by test and practice characteristics. Research in specific clinical contexts is needed to determine whether the observed variation reflects appropriate or inappropriate care. One potential way to reduce unwanted variation would be to offer widespread reflexive testing by pathology for guideline-endorsed predictive somatic tests.

Original languageEnglish (US)
Pages (from-to)e185-e196
JournalJournal of Oncology Practice
Volume13
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Colorectal Neoplasms
Lung Neoplasms
Non-Small Cell Lung Carcinoma
Guidelines
Oncologists
Integrated Delivery of Health Care
Hereditary Nonpolyposis Colorectal Neoplasms
Microsatellite Instability
DNA Mismatch Repair
Colon
Pathology
Delivery of Health Care
Research

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Gray, S. W., Kim, B., Sholl, L., Cronin, A., Parikh, A. R., Klabunde, C. N., ... Keating, N. L. (2017). Medical oncologists' experiences in using genomic testing for lung and colorectal cancer care. Journal of Oncology Practice, 13(3), e185-e196. https://doi.org/10.1200/JOP.2016.016659

Medical oncologists' experiences in using genomic testing for lung and colorectal cancer care. / Gray, Stacy W.; Kim, Benjamin; Sholl, Lynette; Cronin, Angel; Parikh, Aparna R.; Klabunde, Carrie N.; Kahn, Katherine L.; Haggstrom, David; Keating, Nancy L.

In: Journal of Oncology Practice, Vol. 13, No. 3, 01.03.2017, p. e185-e196.

Research output: Contribution to journalReview article

Gray, SW, Kim, B, Sholl, L, Cronin, A, Parikh, AR, Klabunde, CN, Kahn, KL, Haggstrom, D & Keating, NL 2017, 'Medical oncologists' experiences in using genomic testing for lung and colorectal cancer care', Journal of Oncology Practice, vol. 13, no. 3, pp. e185-e196. https://doi.org/10.1200/JOP.2016.016659
Gray, Stacy W. ; Kim, Benjamin ; Sholl, Lynette ; Cronin, Angel ; Parikh, Aparna R. ; Klabunde, Carrie N. ; Kahn, Katherine L. ; Haggstrom, David ; Keating, Nancy L. / Medical oncologists' experiences in using genomic testing for lung and colorectal cancer care. In: Journal of Oncology Practice. 2017 ; Vol. 13, No. 3. pp. e185-e196.
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abstract = "Purpose Genomic testing improves outcomes for many at-risk individuals and patients with cancer; however, little is known about how genomic testing for non-small-cell lung cancer (NSCLC) and colorectal cancer (CRC) is used in clinical practice. Patients and Methods In 2012 to 2013,wesurveyed medical oncologists whocare for patients in diverse practice and health care settings across the United States about their use of guideline-And non-guideline-endorsed genetic tests. Multivariable regression models identified factors that are associated with greater test use. Results Of oncologists, 337 completed the survey (participation rate, 53{\%}). Oncologists reported higher use of guideline-endorsed tests (eg, KRAS for CRC; EGFR for NSCLC) than non-guideline-endorsed tests (eg, OncotypeDX Colon; ERCC1 for NSCLC).Many oncologists reported having no patients with CRC who had mismatch repair and/or microsatellite instability (24{\%}) or germline Lynch syndrome (32{\%}) testing, and no patients with NSCLCwho had ALK testing (11{\%}).Of oncologists, 32{\%} reported that five or fewer patients had KRAS and EGFR testing for CRC and NSCLC, respectively. Oncologists, rather than pathologists or surgeons, ordered the vast majority of tests. In multivariable analyses, fewer patients in nonprofit integrated health care delivery systems underwent testing than did patients in hospital or office-based single-specialty group settings (all P,.05).High patient volume and patient requests (CRC only) were also associated with higher test use (all P , .05). Conclusion Genomic test use for CRC and NSCLC varies by test and practice characteristics. Research in specific clinical contexts is needed to determine whether the observed variation reflects appropriate or inappropriate care. One potential way to reduce unwanted variation would be to offer widespread reflexive testing by pathology for guideline-endorsed predictive somatic tests.",
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N2 - Purpose Genomic testing improves outcomes for many at-risk individuals and patients with cancer; however, little is known about how genomic testing for non-small-cell lung cancer (NSCLC) and colorectal cancer (CRC) is used in clinical practice. Patients and Methods In 2012 to 2013,wesurveyed medical oncologists whocare for patients in diverse practice and health care settings across the United States about their use of guideline-And non-guideline-endorsed genetic tests. Multivariable regression models identified factors that are associated with greater test use. Results Of oncologists, 337 completed the survey (participation rate, 53%). Oncologists reported higher use of guideline-endorsed tests (eg, KRAS for CRC; EGFR for NSCLC) than non-guideline-endorsed tests (eg, OncotypeDX Colon; ERCC1 for NSCLC).Many oncologists reported having no patients with CRC who had mismatch repair and/or microsatellite instability (24%) or germline Lynch syndrome (32%) testing, and no patients with NSCLCwho had ALK testing (11%).Of oncologists, 32% reported that five or fewer patients had KRAS and EGFR testing for CRC and NSCLC, respectively. Oncologists, rather than pathologists or surgeons, ordered the vast majority of tests. In multivariable analyses, fewer patients in nonprofit integrated health care delivery systems underwent testing than did patients in hospital or office-based single-specialty group settings (all P,.05).High patient volume and patient requests (CRC only) were also associated with higher test use (all P , .05). Conclusion Genomic test use for CRC and NSCLC varies by test and practice characteristics. Research in specific clinical contexts is needed to determine whether the observed variation reflects appropriate or inappropriate care. One potential way to reduce unwanted variation would be to offer widespread reflexive testing by pathology for guideline-endorsed predictive somatic tests.

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