By Marilynn Larkin
NEW YORK (Reuters Health) - While most oncologists say genomic sequencing is an important advance, close to two thirds say only a small percentage of their patients might benefit, according to a Medscape survey on genomics testing.
At least a dozen companies now offer multigene testing panels. To assess how and when oncologists are using these panels and how such tests are paid for, Dr. Jack West, Medical Director, Thoracic Oncology Program at the Swedish Cancer Institute in Seattle, Washington worked with Medscape to recruit 89 hematologists/oncologists and 43 medical oncologists for an email survey from December 2016 to February 2017.
About 6% of respondents had been practicing for less than four years; 30% for five to nine years, 42% from 10 to 24 years and 23% for 25 or more years. Roughly half were under age 44, half owned their own practice or worked in a hospital setting and about half worked in an urban setting.
About 87% had used genomic testing. Of that group, 67% had used it in the month prior to the survey. Sixty-six percent used the tests to guide treatment decisions and 16% to guide patients to clinical trials.
Nonetheless, 55% of respondents felt genomic testing is overpromoted and that its value is low or far below expectations.
Among the concerns, 31% said genomic tests too rarely provide actionable, evidence-based information and 17% felt they’re not cost-effective. Eighty-six percent said more physician education is needed before widespread genomic testing can be advocated.
Insurance coverage was a concern for 84% of respondents. Seventy-eight percent said insurers should reimburse for genomic testing, and 85% of those who ordered genomic tests within the past year said they were paid for by patients’ private health insurance.
Seventy-three percent felt getting approval for an unapproved indication is a “hurdle” that “most of the time” precludes the use of genomic test results for precision medicine.
More than half expressed concerns about the clinical reliability and validity of the results provided by commercial genomic testing companies.
Close to half also eschewed the use of genetic testing for clinical trial enrollment, stating it was useful “less than 10% of the time.”
Dr. West told Reuters Health, “There is ambivalence among the broader community of treating oncologists about genomic testing, and there are well-founded concerns.”
“The marketing and mass media too often portray genomic testing as the answer to personalized medicine for patients with cancer,” he said by email. “However . . . oncologists report that these tests yield results that only rarely direct patients to beneficial new treatments.”
“The costs of the testing and potential treatments based on uncommon mutations remain a well-founded concern for both patients and physicians,” Dr. West continued.
“We don't yet have enough data to consider either broad genomic testing or the molecularly directed therapies for rarer mutations a clear standard of care, despite the promise and compelling rationale for them,” he acknowledged.
Dr. West observed, “It isn't surprising that many oncologists have expressed concerns about the confusion, the lack of any clear direction about how to weigh these options, and whether our interventions are financially sustainable for our patients or society at large.”
“Right now,” he said, “we are at a turning point for genomic testing and molecular oncology, and the . . . survey results reflect that.”
“Despite their concerns, nine out of 10 practicing oncologists believe that genomic testing will be routinely useful in the coming years,” Dr. West noted. “Though there are concerns about reliability of test results, I believe the key conclusion is that we need to have realistic expectations, both as patients and physicians, about the promise as well as limitations.”
Dr. Benjamin Neel, director of the Perlmutter Cancer Center at NYU Langone Medical Center in New York City, told Reuters Health, “The survey is correct in that at this point in time, relatively few patients actually benefit from next generation sequencing.”
“However,” said Dr. Neel, who was not involved in the survey, “this conclusion can be somewhat misleading because as new drugs are developed, and as we get more sequencing information, we will be able to improve its use in the care of more and more people.”
“It's kind of like the early days of computers,” he said by email. “Many people purchased them more as luxury items or as fancy toys - but now they are indispensable parts of everyday life that no one can imagine doing without.”
“By using computers and seeing what they could do, we were able, over time, to increase their value, but also increase our own efficiency,” Dr. Neel said. “That is where next-generation sequencing is today.”
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