A systematic review of knowledge, attitude and practice of pharmacogenomics in pediatric oncology patients

Abstract

Pharmacogenomics remains underutilized in clinical practice, despite the existence of internationally recognized, evidence‐based guidelines. This systematic review aims to understand enablers and barriers to pharmacogenomics implementation in pediatric oncology by assessing the knowledge, attitudes, and practice of healthcare professionals and consumers. Medline, Embase, Emcare, and PsycINFO database searches identified 146 relevant studies of which only three met the inclusion criteria. These studies reveal that consumers were concerned with pharmacogenomic test costs, insurance discrimination, data sharing, and privacy. Healthcare professionals possessed mostly positive attitudes toward pharmacogenomic testing yet identified lack of experience and training as barriers to implementation. Education emerged as the key enabler, reported in all three studies and both healthcare professionals and consumer groups. However, despite the need for education, no studies utilizing a pediatric oncology consumer or healthcare professional group have reported on the implementation or analysis of a pharmacogenomic education program in pediatric oncology. Increased access to guidelines, expert collaborations and additional guidance interpreting results were further enablers established by healthcare professionals. The themes identified mirror those reported in broader pediatric genetic testing literature. As only a small number of studies met inclusion criteria for this review, further research is warranted to elicit implementation determinants and advance pediatric pharmacogenomics.

Minimising Adverse Drug Reactions and Verifying Economic Legitimacy-Pharmacogenomics Implementation in Children (MARVEL- PIC): protocol for a national randomised controlled trial of pharmacogenomics implementation

“…One international barrier to the widespread uptake of pharmacogenomic testing is the lack of evidence available to support its approach. 7 While some institutes have initiated pre-emptive testing in paediatric patients (ie, St Jude Children’s Research Hospital 8 ), the approach is not widely adopted. The Pre-emptive Pharmacogenomic Testing for Preventing Adverse Drug Reactions [ PREPARE trial 9 ]from the Dutch group is the only study to date (in an Adult population) that has proven pre-emptive prescribing reduces ADRs in a broad cohort.…”

Healthcare provider and patient perspectives on the implementation of pharmacogenetic-guided treatment in routine clinical practice

“…Furthermore, PGx tests at the PoC are not regularly used in routine clinical practice with one study even showing that some psychiatrists prefer to utilize standard therapy for patients with bipolar disorder despite PGx testing suggesting a more effective alternative treatment [14]. Previous survey studies that have investigated healthcare provider and patient opinions on PGx testing have primarily investigated the knowledge and attitudes of healthcare providers as well as barriers to implementation [15] and most of those investigations are targeted toward a subgroup of healthcare providers and patients [16][17][18], limiting the generalizability of the research outcomes. Patient studies typically involve individuals who have prior general knowledge about PGx testing or have undergone PGx testing previously [19,20].…”