1. 'Game Changer': Health Professionals' Views on the Clinical Utility of Circulating Tumor DNA Testing in Hereditary Cancer Syndrome Management
- Author
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Shickh, S, Oldfield, LE, Clausen, M, Mighton, C, Sebastian, A, Calvo, A, Baxter, NN, Dawson, L, Penney, LS, Foulkes, W, Basik, M, Sun, S, Schrader, KA, Regier, DA, Karsan, A, Pollett, A, Pugh, TJ, Kim, RH, Bombard, Y, Shickh, S, Oldfield, LE, Clausen, M, Mighton, C, Sebastian, A, Calvo, A, Baxter, NN, Dawson, L, Penney, LS, Foulkes, W, Basik, M, Sun, S, Schrader, KA, Regier, DA, Karsan, A, Pollett, A, Pugh, TJ, Kim, RH, and Bombard, Y
- Abstract
BACKGROUND: We explored health professionals' views on the utility of circulating tumor DNA (ctDNA) testing in hereditary cancer syndrome (HCS) management. MATERIALS AND METHODS: A qualitative interpretive description study was conducted, using semi-structured interviews with professionals across Canada. Thematic analysis employing constant comparison was used for analysis. 2 investigators coded each transcript. Differences were reconciled through discussion and the codebook was modified as new codes and themes emerged from the data. RESULTS: Thirty-five professionals participated and included genetic counselors (n = 12), geneticists (n = 9), oncologists (n = 4), family doctors (n = 3), lab directors and scientists (n = 3), a health-system decision maker, a surgeon, a pathologist, and a nurse. Professionals described ctDNA as "transformative" and a "game-changer". However, they were divided on its use in HCS management, with some being optimistic (optimists) while others were hesitant (pessimists). Differences were driven by views on 3 factors: (1) clinical utility, (2) ctDNA's role in cancer screening, and (3) ctDNA's invasiveness. Optimists anticipated ctDNA testing would have clinical utility for HCS patients, its role would be akin to a diagnostic test and would be less invasive than standard screening (eg imaging). Pessimistic participants felt ctDNA testing would add limited utility; it would effectively be another screening test in the pathway, likely triggering additional investigations downstream, thereby increasing invasiveness. CONCLUSIONS: Providers anticipated ctDNA testing will transform early cancer detection for HCS families. However, the contrasting positions on ctDNA's role in the care pathway raise potential practice variations, highlighting a need to develop evidence to support clinical implementation and guidelines to standardize adoption.
- Published
- 2022