Use of Next-Generation Sequencing Tests to Guide Cancer Treatment: Results From a Nationally Representative Survey of Oncologists in the United States

Abstract

Purpose There are no nationally representative data on oncologists’ use of next-generation sequencing (NGS) testing in practice. The purpose of this study was to investigate how oncologists in the United States use NGS tests to evaluate patients with cancer and to inform treatment recommendations. Methods The study used data from the National Survey of Precision Medicine in Cancer Treatment, which was mailed to a nationally representative sample of oncologists in 2017 (N = 1,281; cooperation rate = 38%). Weighted percentages were calculated to describe NGS test use. Multivariable modeling was conducted to assess the association of test use with oncologist practice characteristics. Results Overall, 75.6% of oncologists reported using NGS tests to guide treatment decisions. Of these oncologists, 34.0% used them often to guide treatment decisions for patients with advanced refractory disease, 29.1% to determine eligibility for clinical trials, and 17.5% to decide on off-label use of Food and Drug Administration–approved drugs. NGS test results informed treatment recommendations often for 26.8%, sometimes for 52.4%, and never or rarely for 20.8% of oncologists. Oncologists younger than 50 years of age, holding a faculty appointment, having genomics training, seeing more than 50 unique patients per month, and having access to a molecular tumor board were more likely to use NGS tests. Conclusion In 2017, most oncologists in the United States were using NGS tests to guide treatment decisions for their patients. More research is needed to establish the clinical usefulness of these tests, to develop evidence-based clinical guidelines for their use in practice, and to ensure that patients who can benefit from these new technologies receive appropriate testing and treatment.

Molecular profiling for precision cancer therapies

“…Younger oncologists have been found to be more likely to use NGS testing than older colleagues. Physicians who have access to an MTB have also been found to increase their use of NGS [95]. MTB can improve clinicians' understanding of assay strengths, limitations, and results; can increase oncologists' confidence in the application of molecular diagnostics; and ultimately can enhance the success of precision medicine.…”

Comparison of commonly used solid tumor targeted gene sequencing panels for estimating tumor mutation burden shows analytical and prognostic concordance within the cancer genome atlas cohort

“…Recent survey data indicates that 75% of oncologists across practice types and sizes routinely use NGS data to guide patient care decisions. 19 Many commercially available and laboratory-developed NGS based tumor profiling assays also include an evaluation of TMB.…”

Harnessing the Power of Collaboration and Training Within Clinical Data Science to Generate Real‐World Evidence in the Era of Precision Oncology

“…Evidence on the diffusion and effectiveness of targeted oncology therapeutics as they emerge in the real world through standard or accelerated approval is necessary to evaluate clinical outcomes and survivorship; therefore, it is essential to complement RCTs in oncology with RWE derived from observational data. An NCI survey of US oncologists showed >75% use next‐generation sequencing to guide treatment decisions, in the absence of next generation sequencing–specific guidelines or documented clinical usefulness due to limited RWE/RWD . Frustrating hurdles surround RWD utilization; patients seek care across the fractionated healthcare system through care settings (inpatient and outpatient) across clinical specialties generating a multitude of data from each encounter documented within disparate health information systems contributing to extensive heterogeneity.…”