title: Integrating next-generation sequencing into pediatric oncology practice: An assessment of physician confidence and understanding of clinical genomics.
abstract: BACKGROUND
  The incorporation of genomic testing to identify targetable somatic alterations and predisposing germline mutations into the clinical setting is becoming increasingly more common. Despite its potential usefulness, to the authors' knowledge physician confidence with regard to understanding and applying genomic testing remains unclear, particularly within the realm of pediatric oncology.
  
  
  METHODS
  Before initiating an institutional feasibility study regarding the integration of clinical genomic testing, the authors surveyed pediatric oncologists regarding their confidence around understanding of genomic testing, perceived usefulness of test results, preferences around the disclosure of germline test results, and possible risks and benefits of testing.
  
  
  RESULTS
  Among survey respondents (52 of 88 contacted; response rate of 59%), only a minority were confident in interpreting, using, and discussing somatic (35%) or germline (27%) genomic test results. Providers who were confident in interpreting somatic results were significantly more likely to anticipate using the results to plan the treatment of patients with relapsed or refractory cancers (P = .009). Similarly, providers who reported confidence in interpreting germline results were significantly more likely to discuss and use these results as part of clinical care (P<.0001). The majority of physicians (93%), regardless of their level of confidence, wanted to speak to a genetic counselor before disclosing germline test results.
  
  
  CONCLUSIONS
  Among physicians at a comprehensive pediatric cancer center, confidence in the interpretation, use, and discussion of oncology-based genomic test results appears to be low, both in terms of somatic and germline testing. To optimize the integration of genomic sequencing into cancer care, methods must be developed to improve basic competencies around cancer-based genomic testing. Given the complexities surrounding variant interpretation and genotype-phenotype relationships, interdisciplinary collaborations are warranted. Cancer 2017;123:2352-2359. © 2017 American Cancer Society.
authors.affiliation: Division of Hospitalist Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Liza-Marie
authors.initials: LM
authors.lastname: Johnson
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Valdez
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Quinn
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: April D
authors.initials: AD
authors.lastname: Sykes
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Rose B
authors.initials: RB
authors.lastname: McGee
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Regina
authors.initials: R
authors.lastname: Nuccio
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Stacy J
authors.initials: SJ
authors.lastname: Hines-Dowell
authors.affiliation: Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Chimene
authors.initials: C
authors.lastname: Kesserwan
authors.affiliation: Division of Cancer Predisposition, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Nichols
authors.affiliation: Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Belinda N
authors.initials: BN
authors.lastname: Mandrell
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D030881:Disclosure; D005817:Genetic Counseling; D005820:Genetic Testing; D023281:Genomics; D018095:Germ-Line Mutation; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008495:Medical Oncology; D009154:Mutation; D009369:Neoplasms / Q000235:genetics*; D010372:Pediatrics; D010820:Physicians; D011795:Surveys and Questionnaires
keywords: cancer genomics; clinical genomics; pediatric oncology; provider confidence