title: Next-Generation Testing for Cancer Risk: Perceptions, Experiences, and Needs Among Early Adopters in Community Healthcare Settings.
abstract: BACKGROUND
  Advances in next-generation sequencing (NGS) technologies are driving a shift from single-gene to multigene panel testing for clinical genetic cancer risk assessment (GCRA). This study explored perceptions, experiences, and challenges with NGS testing for GCRA among U.S. community-based clinicians.
  
  
  METHODS
  Surveys delivered at initial and 8-month time points, and 12-month tracking of cases presented in a multidisciplinary web-based case conference series, were conducted with GCRA providers who participated in a 235-member nationwide community of practice.
  
  
  RESULTS
  The proportion of respondents ordering panel tests rose from 29% at initial survey (27/94) to 44% (46/107) within 8 months. Respondents reported significantly less confidence about interpreting and counseling about NGS compared with single-gene test results (p < 0.0001 for all comparisons). The most cited reasons for not ordering NGS tests included concerns about clinical utility, interpreting and communicating results, and lack of knowledge/skills. Multigene panels were used in 204/668 cases presented during 2013, yielding 37 (18%) deleterious (7% in low/moderate-penetrance genes), 88 (43%) with ≥1 variant of uncertain significance, 77 (38%) uninformative negative, and 2 (1%) inconclusive results.
  
  
  CONCLUSIONS
  Despite concerns about utility and ability to interpret/counsel about NGS results, a rapidly increasing uptake of NGS testing among community clinicians was documented. Challenges identified in case discussions point to the need for ongoing education, practice-based support, and opportunities to partner in research that contributes to characterization of lesser known genes.
authors.affiliation: 1 City of Hope, Division of Clinical Cancer Genetics , Duarte, California.
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Blazer
authors.affiliation: 1 City of Hope, Division of Clinical Cancer Genetics , Duarte, California.
authors.forename: Bita
authors.initials: B
authors.lastname: Nehoray
authors.affiliation: 1 City of Hope, Division of Clinical Cancer Genetics , Duarte, California.
authors.forename: Ilana
authors.initials: I
authors.lastname: Solomon
authors.affiliation: 1 City of Hope, Division of Clinical Cancer Genetics , Duarte, California.
authors.forename: Mariana
authors.initials: M
authors.lastname: Niell-Swiller
authors.affiliation: 1 City of Hope, Division of Clinical Cancer Genetics , Duarte, California.
authors.forename: Julie O
authors.initials: JO
authors.lastname: Culver
authors.affiliation: 2 Vital Research , Los Angeles, California.
authors.forename: Gwen C
authors.initials: GC
authors.lastname: Uman
authors.affiliation: 1 City of Hope, Division of Clinical Cancer Genetics , Duarte, California.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Weitzel
mesh_terms: D003153:Community Health Services; D005260:Female; D005820:Genetic Testing; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000235:genetics; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires