TAILIEUCHUNG - Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies: A qualitative study of barriers to implementation

Pharmacogenetic (PGx) testing for germline variants in the DPYD and UGT1A1 genes can be used to guide fuoropyrimidine and irinotecan dosing, respectively. Despite the known association between PGx variants and chemotherapy toxicity, preemptive testing prior to chemotherapy initiation is rarely performed in routine practice. | Lau Min et al. BMC Cancer 2022 22 47 https s12885-022-09171-6 RESEARCH Open Access Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies a qualitative study of barriers to implementation Kelsey S. Lau Min1 Lisa A. Varughese2 Maria N. Nelson3 Christine Cambareri4 Nandi J. Reddy5 Randall A. Oyer5 Ursina R. Teitelbaum1 and Sony Tuteja2 Abstract Background Pharmacogenetic PGx testing for germline variants in the DPYD and UGT1A1 genes can be used to guide fluoropyrimidine and irinotecan dosing respectively. Despite the known association between PGx variants and chemotherapy toxicity preemptive testing prior to chemotherapy initiation is rarely performed in routine practice. Methods We conducted a qualitative study of oncology clinicians to identify barriers to using preemptive PGx testing to guide chemotherapy dosing in patients with gastrointestinal malignancies. Each participant completed a semi-structured interview informed by the Consolidated Framework for Implementation Research CFIR . Interviews were analyzed using an inductive content analysis approach. Results Participants included sixteen medical oncologists and nine oncology pharmacists from one academic medical center and two community hospitals in Pennsylvania. Barriers to the use of preemptive PGx testing to guide chemotherapy dosing mapped to four CFIR domains intervention characteristics outer setting inner setting and characteristics of individuals. The most prominent themes included 1 a limited evidence base 2 a cumbersome and lengthy testing process and 3 a lack of insurance coverage for preemptive PGx testing. Additional barriers included clinician lack of knowledge difficulty remembering to order PGx testing for eligible patients challenges with PGx test interpretation a questionable impact of preemptive PGx testing on clinical care and a lack of alternative therapeutic options for some patients found to have actionable PGx .

• Y khoa - Dược
• BMC Cancer
• Pharmacogenetic testing
• Chemotherapy dosing
• Gastrointestinal cancers
• Barriers to implementation
• Cancer patient pathways
• Colorectal cancer
• Lung cancer
• Breast cancer
• Prostate cancer
• Ovarian cancer
• Cancer detection
• Ovarian cancer symptoms
• Ovarian cancer signs
• Ovarian cancer tests
• Cancer biomarkers
• Pediatric cancer
• Familial cancer predisposition
• Hereditary cancer syndrome
• Genetic cancer susceptibility
• Advanced cancer
• Biliary tract cancer
• Multimodal intervention
• Pancreatic cancer
• Physical activity
• Breast cancer screening
• Familial breast cancer
• Young breast cancer survivors
• High risk relatives
• Randomized trial
• Childhood cancer
• Childhood cancer survivor
• Thyroid cancer screening
• Secondary cancer
• Cancer screening
• Community awareness
• Cancer education
• Cervical cancer
• Prior cancer
• Cancer survivors
• Cancer registry
• Second cancer
• Surgical oncology
• Cancer imaging
• Radiation oncologists
• Medical oncologists
• Oesophagogastric cancer
• Liver cancer
• Hepatobiliary cancer
• Multidisciplinary rehabilitation
• EGFR mutation
• Family history of cancer
• Inherited susceptibility
• Cancer predisposition genes
• Lung cancer aetiology
• Cancer stem cells
• Oct4 overexpressing lung cancer
• Human lung cancer xenograft model
• Disease free survivals
• Cancer hallmarks
• Cancer genesis
• Defiant disease
• Mutational signature
• Cancer diagnosis
• Cancer genomics
• Molecular medicine
• Whole genome sequencing
• Cancer susceptibility gene
• Breast cancer prognosis
• Next generation sequencing
• Quality of care
• Quality indicators
• Shifting cancer care
• German cancer society
• Colorectal cancer screening
• Stomach cancer screening
• Lung cancer survivor
• Physician recommendation
• Total number of lymph nodes
• Lymph node ratio
• Left colon cancer
• Right colon cancer
• Overall survival
• Cumulative incidence
• Esophageal cancer
• Head and neck cancer
• Metachronous cancer
• Young onset
• Reproductive cancer
• Risk factor
• Early detection of cancer
• Gastric cancer incidence
• Population based specialized registry
• Gastric cancer survival
• Gastric cancer clinical characteristics
• Gastric cancer pathological characteristics
• Lung Cancer Screening
• Racial disparities
• Lung Cancer diagnosis
• Screening adherence
• Second primary colorectal cancer
• Standardized incidence ratio
• Left sided colon cancer
• Right sided colon cancer
• Quality of cancer care
• Population based study