New insights on oncologist use of genomic testing.

Abstract

e18741 Background: As the indications and complexity of precision medicine in oncology increase, we sought information about current provider needs and experiences. Methods: In early 2023, we conducted qualitative interviews with medical oncologists who reported treating patients with lung, breast, and/or colorectal cancer. Questions focused on use, concerns, patient communication, resources, and needs related to genomic testing and precision medicine. Results: A total of 24 oncologists were interviewed (50% in practice > 20 years, 71% at community sites, 88% general oncology). Three patterns of tumor genomic testing emerged: (1) Frequent use and an exploratory mindset; (2) measured use, often with a limited set of alterations tested initially, focused on actionable findings; and (3) infrequent use, requiring availability of effective and affordable treatment. Concerns included turnaround time (particularly for lung cancer), workflow and electronic medical record (EMR) non-integration, non-actionable results, cost, and tissue adequacy. Most respondents find test results easy to use, focusing on the first two pages; some use the entire report. Respondents identified problems securing patient access to indicated targeted therapies, particularly oral agents with costly copays requiring substantial staff administrative effort, with the greatest challenges faced by underinsured rather than uninsured patients. Recommendations included improving EMR integration, shortening time-to-result, reflex performance so results are available at initial oncology appointment, standardizing result presentation, and addressing cost issues. In addition, some suggested that centralized collection and analysis of patient outcome data would inform questions of actionability and access. Conclusions: This qualitative work identifies several major challenges practicing oncologists face in delivering precision medicine. Notably, downstream issues related to treatment access may influence decisions regarding tumor genomic profiling. Further investigation of barriers and potential solutions is needed.