title: Pediatric Oncology Provider Views on Performing a Biopsy of Solid Tumors in Children with Relapsed or Refractory Disease for the Purpose of Genomic Profiling.
abstract: Patients with relapsed and refractory solid tumors have a poor prognosis. Recent advances in genomic technology have made it feasible to screen tumors for actionable mutations, with the anticipation that this may provide benefit to patients.
  
  
  
  Pediatric oncologists were emailed an anonymous 34-question survey assessing their willingness to offer a rebiopsy to patients with relapsed disease for the purpose of tumor genomic profiling. They were presented with two scenarios evaluating morbidity and invasiveness of the procedures using the clinical examples of medulloblastoma and Ewing sarcoma.
  
  
  
  A total of 195 pediatric oncologists responded to the questionnaire. Morbidity and invasiveness of the procedure demonstrated significant differences in provider willingness to refer their patients for rebiopsy. The pretest probability was a major variable influencing provider willingness to offer a rebiopsy. Respondents were more likely to offer a rebiopsy if the likelihood was high that the results would have an impact on clinical management than if the biopsy was for histologic confirmation alone (mean 89 vs. 56 %; p = 0.017). Compared with the rate of a rebiopsy for histologic confirmation, significantly fewer providers were willing to offer a rebiopsy if they were led to believe the likelihood of finding an actionable mutation was low (mean 45 vs. 56 %; p = 0.021).
  
  
  
  The scenario showed that the pretest probability of finding an actionable mutation was influential in determining provider willingness to offer a rebiopsy for the purpose of tumor genomic profiling. Further research is warranted to evaluate the benefit of tumor genomic profiling in terms of patient outcomes.
authors.affiliation: Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Barrie
authors.initials: B
authors.lastname: Cohen
authors.affiliation: Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Roth
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Marron
authors.affiliation: Dana-Farber Cancer Institute, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Stacy W
authors.initials: SW
authors.lastname: Gray
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Geller
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Bang
authors.initials: B
authors.lastname: Hoang
authors.affiliation: Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.|Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Gorlick
authors.affiliation: Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Janeway
authors.affiliation: Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA. jgill@montefiore.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gill
mesh_terms: D001291:Attitude of Health Personnel; D001706:Biopsy / Q000009:adverse effects / Q000941:ethics / Q000706:statistics & numerical data; D001859:Bone Neoplasms / Q000235:genetics / Q000473:pathology*; D002528:Cerebellar Neoplasms / Q000235:genetics / Q000473:pathology*; D002648:Child; D000066491:Clinical Decision-Making; D005260:Female; D020869:Gene Expression Profiling / Q000706:statistics & numerical data; D023281:Genomics; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008527:Medulloblastoma / Q000235:genetics / Q000473:pathology*; D058990:Molecular Targeted Therapy; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000235:genetics / Q000473:pathology*; D010353:Patient Education as Topic; D010372:Pediatrics; D018570:Risk Assessment; D012512:Sarcoma, Ewing / Q000235:genetics / Q000473:pathology*; D020377:Self Efficacy