Oncologists’ attitudes toward KRAS testing: a multisite study

Abstract

Recent discoveries promise increasingly to help oncologists individually tailor anticancer therapy to their patients’ molecular tumor characteristics. One such promising molecular diagnostic is Kirsten ras (KRAS) tumor mutation testing for metastatic colorectal cancer (mCRC) patients. In the current study, we examined how and why physicians adopt KRAS testing and how they subsequently utilize the information when discussing treatment strategies with patients. We conducted 34 semi-structured in-person or telephone interviews with oncologists from seven different health plans. Each interview was audiotaped, transcribed, and coded using qualitative research methods. Information and salient themes relating to the research questions were summarized for each interview. All of the oncologists in this study reported using the KRAS test at the time of the interview. Most appeared to have adopted the test rapidly, within 6 months of the publication of National Clinical Guidelines. Oncologists chose to administer the test at various time points, although the majority ordered the test at the time their patient was diagnosed with mCRC. While oncologists expressed a range of opinions about the KRAS test, there was a general consensus that the test was useful and provided benefits to mCRC patients. The rapid adoption and enthusiasm for KRAS suggests that these types of tests may be filling an important informational need for oncologists when making treatment decisions. Future research should focus on the informational needs of patients around this test and whether patients feel informed or confident with their physicians’ use of these tests to determine treatment access.

Panitumumab Use in Metastatic Colorectal Cancer and Patterns of KRAS Testing: Results from a Europe-Wide Physician Survey and Medical Records Review

“…In the physician survey, we have shown that by 2012, the percentage of participating physicians adopting tumor KRAS testing was nearly 100% in Europe. Previous physician surveys in 2010 following published guidance recommending the adoption of KRAS testing prior to EGFR-targeted treatment [ 18 , 19 ] found that the range of adoption varied widely (20–100%) across countries [ 20 – 22 ]. In Europe in 2010, physicians used clinical judgment when deciding whether or not to test mCRC KRAS status prior to treatment with EGFR-targeted therapies, with 73% of participating physicians testing mCRC KRAS status prior to prescribing EGFR-targeted therapies [ 20 ].…”

“…Previous physician surveys have found that in 2010, when guidelines first recommended testing for KRAS status [ 18 , 19 ], the adoption of KRAS testing prior to treating patients with EGFR inhibitors varied widely [ 20 – 22 ]. In 2010, 73% (326/448) of participating physicians in Europe reported undertaking appropriate KRAS testing when mCRC was diagnosed, compared with 63% (160/256) in Latin America and 20% (28/139) in Asia [ 20 ].…”

“…In the US, a survey carried out in 2010 reported that of 1,242 physicians responding, only one-fifth of those who had treated mCRC had ordered or recommended KRAS testing [ 21 ]. In contrast in another study, a more targeted identification of oncologists treating mCRC found that in 2010 all oncologists (34/34) tested tumor KRAS status [ 22 ].…”

Advanced cancer patients’ attitudes towards, and experiences with, screening for somatic mutations in tumours: a qualitative study

“…). As adoption of NGS methods in tumour screening increases, however, there will be a need to revise research on patients' attitudes and experiences.With somatic tumour screening being embraced by oncologists to fill an informational need when making treatment decisions(Gray, Hicks-Courant, Cronin, Rollins, & Weeks, 2014;Harris et al, 2013; This may influence test interest(Meiser, Storey, Quinn, Rahman, & Andrews, 2016), asGray et al (2012) found that cancer patients were less willing to undergo germline cancer risk testing with the potential of yielding incidental information (81%), compared to somatic testing to guide treatment selection (96%).…”

A survey of physician receptivity to molecular diagnostic testing and readiness to act on results for early-stage colon cancer patients

“…Physicians who care for cancer patients are challenged by the need to learn about new developments in the field and the demand to apply these new tools in patient care [ 1 ]. Realizing the potential benefits of molecular diagnostic testing in cancer care will require high levels of physician receptivity and readiness to use such tests routinely [ 2 , 3 ]. To date, however, limited research has reported on physician receptivity to and use of molecular diagnostic testing in cancer care [ 4 ].…”