National Survey Pinpoints Reasons Oncologists Do Not Order Molecular Testing

Multimarker tumor panel testing is beneficial in helping to inform treatment choice in precision oncology. However, little is known about the clinic-based and organizational factors related to multimarker tumor panel testing, and why oncologists may not choose this testing.

In a recent study, Megan C. Roberts, PhD, Director, Implementation Science in Precision Health and Society, Eshelman School of Pharmacy, and Member, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, and colleagues examined oncologist-reported factors for not ordering multimarker panels for their patients. They also looked at the association between these reasons and oncologists’ provider-level, facility-level, and patient-mix characteristics.

“This information is important to fully understand the testing landscape and to identify factors that should be addressed to foster appropriate use of multimarker tumor panel testing in practice,” commented Roberts and colleagues.

The researchers used data collected from a nationally representative sample of 1281 medical oncologists who are participating in the National Cancer Institute’s National Survey of Precision Medicine in Cancer Treatment. Oncologists currently practicing, not in training, and younger than 75 years were eligible to participate. The majority (62%) of oncologists were affiliated with academic institutions, and approximately half (54%) practiced in urban areas versus 10% in rural locations. Overall, 56% of the oncologists surveyed had some formal genomic training.

The oncologists reported multiple reasons for not ordering molecular profiling. The 2 main drivers were relevance (78%) and the tests’ clinical utility (77%). Other frequently reported reasons for not ordering multimarker tumor panels were difficulty obtaining sufficient tissue for testing (57%) and using individual gene tests (72%).

A small percentage of oncologists cited uncertainty regarding informed consent procedures (8%), unavailability of multimarker tumor panels in their practices (17%), not having the personnel resources to interpret the results (12%), and time constraints to order or review the results (25%) were often factors for not using these tests.

Roberts and colleagues noted that oncologists seeing patients in academic centers or at facilities with access to genomic testing services were less likely to report difficulty in obtaining enough tissue for testing or uncertainty about informed consent procedures as factors for not ordering such testing.

The results also showed that no provider-level, facility-level, or patient-mix characteristics were linked with testing not being relevant as a reason for not using multimarker tumor panel testing.

“The use of multimarker tumor panels is largely driven by clinical utility and relevance. However, we also identified modifiable reasons for not using multimarker tumor panel tests on the provider and organizational levels that can be targets of multilevel interventions,” Roberts and colleagues noted.

“Organizations without certain genomic services, as well as oncologists without genomics training or who practice in rural and community settings, may be important targets for future studies aimed at increasing appropriate uptake of these tests,” they concluded.

Source: Roberts MC, Spees LP, Freedman AN, et al. Oncologist-reported reasons for not ordering multimarker tumor panels: results from a nationally representative survey. JCO Precis Oncol. 2021;5:701-709.