"Game Changer": Health Professionals' Views on the Clinical Utility of Circulating Tumor DNA Testing in Hereditary Cancer Syndrome Management.
cancer detection
circulating tumor DNA
clinical utility
genomics
hereditary cancer syndromes
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
06 05 2022
06 05 2022
Historique:
received:
10
06
2021
accepted:
14
01
2022
pubmed:
7
4
2022
medline:
11
5
2022
entrez:
6
4
2022
Statut:
ppublish
Résumé
We explored health professionals' views on the utility of circulating tumor DNA (ctDNA) testing in hereditary cancer syndrome (HCS) management. A qualitative interpretive description study was conducted, using semi-structured interviews with professionals across Canada. Thematic analysis employing constant comparison was used for analysis. 2 investigators coded each transcript. Differences were reconciled through discussion and the codebook was modified as new codes and themes emerged from the data. Thirty-five professionals participated and included genetic counselors (n = 12), geneticists (n = 9), oncologists (n = 4), family doctors (n = 3), lab directors and scientists (n = 3), a health-system decision maker, a surgeon, a pathologist, and a nurse. Professionals described ctDNA as "transformative" and a "game-changer". However, they were divided on its use in HCS management, with some being optimistic (optimists) while others were hesitant (pessimists). Differences were driven by views on 3 factors: (1) clinical utility, (2) ctDNA's role in cancer screening, and (3) ctDNA's invasiveness. Optimists anticipated ctDNA testing would have clinical utility for HCS patients, its role would be akin to a diagnostic test and would be less invasive than standard screening (eg imaging). Pessimistic participants felt ctDNA testing would add limited utility; it would effectively be another screening test in the pathway, likely triggering additional investigations downstream, thereby increasing invasiveness. Providers anticipated ctDNA testing will transform early cancer detection for HCS families. However, the contrasting positions on ctDNA's role in the care pathway raise potential practice variations, highlighting a need to develop evidence to support clinical implementation and guidelines to standardize adoption.
Sections du résumé
BACKGROUND
We explored health professionals' views on the utility of circulating tumor DNA (ctDNA) testing in hereditary cancer syndrome (HCS) management.
MATERIALS AND METHODS
A qualitative interpretive description study was conducted, using semi-structured interviews with professionals across Canada. Thematic analysis employing constant comparison was used for analysis. 2 investigators coded each transcript. Differences were reconciled through discussion and the codebook was modified as new codes and themes emerged from the data.
RESULTS
Thirty-five professionals participated and included genetic counselors (n = 12), geneticists (n = 9), oncologists (n = 4), family doctors (n = 3), lab directors and scientists (n = 3), a health-system decision maker, a surgeon, a pathologist, and a nurse. Professionals described ctDNA as "transformative" and a "game-changer". However, they were divided on its use in HCS management, with some being optimistic (optimists) while others were hesitant (pessimists). Differences were driven by views on 3 factors: (1) clinical utility, (2) ctDNA's role in cancer screening, and (3) ctDNA's invasiveness. Optimists anticipated ctDNA testing would have clinical utility for HCS patients, its role would be akin to a diagnostic test and would be less invasive than standard screening (eg imaging). Pessimistic participants felt ctDNA testing would add limited utility; it would effectively be another screening test in the pathway, likely triggering additional investigations downstream, thereby increasing invasiveness.
CONCLUSIONS
Providers anticipated ctDNA testing will transform early cancer detection for HCS families. However, the contrasting positions on ctDNA's role in the care pathway raise potential practice variations, highlighting a need to develop evidence to support clinical implementation and guidelines to standardize adoption.
Identifiants
pubmed: 35385106
pii: 6564276
doi: 10.1093/oncolo/oyac039
pmc: PMC9075003
doi:
Substances chimiques
Circulating Tumor DNA
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e393-e401Subventions
Organisme : CIHR
ID : CIHR-159453
Pays : Canada
Organisme : CIHR
ID : GSD-425969
Pays : Canada
Investigateurs
Trevor J Pugh
(TJ)
Raymond H Kim
(RH)
Yvonne Bombard
(Y)
Adriana Aguilar-Mahecha
(A)
Melyssa Aronson
(M)
Mark Basik
(M)
Nancy N Baxter
(NN)
Hal Berman
(H)
Marcus Q Bernardini
(MQ)
Tulin Cil
(T)
Katie Compton
(K)
Lesa Dawson
(L)
Irfan Dhalla
(I)
Tiana Downs
(T)
Christine Elser
(C)
Gabrielle E V Ene
(GEV)
Kirsten M Farncombe
(KM)
Sarah Ferguson
(S)
William Foulkes
(W)
Robert Gryfe
(R)
Michelle R Jacobson
(MR)
Aly Karsan
(A)
Monika Kastner
(M)
Pardeep Kaurah
(P)
Jordan Lerner-Ellis
(J)
Stephanie Lheureux
(S)
Beatrice Luu
(B)
Shelley MacDonald
(S)
Brian Mckee
(B)
Nicole Mittmann
(N)
Kristen Mohler
(K)
Leslie Oldfield
(L)
Seema Panchal
(S)
Lynette S Penney
(LS)
Carolyn Piccinin
(C)
Aaron Pollett
(A)
Dean Regier
(D)
Zoulikha Rezoug
(Z)
Matthew Richardson
(M)
Anabel Scaranelo
(A)
Kasmintan A Schrader
(KA)
Kara Semotiuk
(K)
Lillian Siu
(L)
Sophie Sun
(S)
Emily Thain
(E)
Gulisa Turashvili
(G)
Karin Wallace
(K)
Thomas Ward
(T)
Shelley Westergard
(S)
Wei Xu
(W)
Celeste Yu
(C)
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press.
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