Most patients with advanced cancer would like to know their cancer-related and incidental whole-exome sequencing results, according to findings of the CanSeq study.
However, patients’ low levels of genetic knowledge and oncologists’ inexperience with large-scale sequencing can make the implementation of whole-exome sequencing into clinical practice challenging, according to the researchers.
Stacy W. Gray, MD, AM, a medical oncologist at Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School, and colleagues sought to determine the attitudes of oncologists about whole-exome sequencing and to identify patient preferences about learning their sequencing results.
Stacy W. Gray
The analysis included data from 167 patients (85% white; 58% women; mean age, 60 years) with stage IV lung or colorectal cancer, as well as from 27 oncologists (22% women) who participated in the study via surveys and interviews.
At least 95% of the patients wanted to learn results that would help identify a potential clinical trial, results that would indicate positive prognosis, and results that would identify a genetic predisposition to cancer or other noncancerous conditions.
Overall, 84% of patients wanted to hear negative results and 85% wanted to hear results related to being predisposed to untreatable, noncancerous conditions.
Although 44% of the participants had completed college-level education or higher, patients displayed a moderately low knowledge of genomics (mean, 4 out of 7 questions correct).
Further, the researchers reported that a sizeable minority of patients were not aware that genetic testing could aid the evaluation of cancer risk.
“Better understanding of genomic test results can empower cancer patients to participate more actively in their own care,” Gray said in a press release. She called for “a patient-centered perspective of what the information means.”
Many oncologists had experience ordering somatic tests (median, 100 per year); however, they had little experience ordering germline tests (median, 2 per year).
Overall, 78% of the oncologists favored disclosing clinically valid genomic results to the patients and 67% favored disclosing them even if they lacked clinical utility but established a relationship between genotype and phenotype.
Fifty-two percent of the oncologists believed patients should be given full access to any results that they requested.
“Providers showed more hesitation when they anticipated disclosing genomic results that would not affect treatments and could raise psychological or psychosocial issues that might call for counseling support,” Gray said. “Finding the right match of information to provide is a familiar challenge for oncologists.”
Data from the surveys also showed that many oncologists are concerned with their ability to keep up genomic information, to be able to use it to act quickly and to make it understandable for patients and their caregivers. – by Anthony SanFilippo
Disclosure: Gray reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.