OBJECTIVES : Despite high utilization of breast cancer gene-specific (BRCA) testing and increasing utilization of homologous recombination deficiency/ homologous recombination repair mutations (HRD/HRRm) testing, barriers to adoption remain. The purpose of this study was to identify barriers to BRCA and HRD/HRRm testing from the physician’s perspective and preferred strategies to optimize the clinical management of cancer.

METHODS : Semi-structured interviews were conducted with a sample of physicians (5 general medical oncologists, 1 primary care provider, 1 breast surgeon, 1 pathologist, and 2 urologic oncologists). Physicians were asked about practice characteristics, perceived barriers to testing, and potential strategies for alleviating these barriers.

RESULTS

: 80% of physicians reported using both tests, while the remainder used BRCA only. All physicians reported experiencing reimbursement challenges for both BRCA and HRD/HRRm, which include barriers in insurance coverage for testing (80%) and challenges in obtaining prior authorization (60%). Physicians reported knowledge barriers for both the patient and physician, as 40% of physicians reported insufficient training on test use and 60% reported difficulty in getting their patients to understand/agree to testing. Resource-related barriers were also reported; all physicians stressed the importance of genetic counselors for interpreting results and ordering appropriate testing, but 30% of physicians reported inadequate access to external and onsite genetic counselors. Some physicians (30%) indicated specific concerns with HRD/HRRm testing due to its complexity and perceived lack of clinical utility. To increase adoption of testing, physicians suggested increasing genetic counseling services, shortening test turnaround time, and making tests cheaper to use. They also desired more educational materials for physicians, patients, and patients’ families.

CONCLUSIONS

: This qualitative study of practicing physicians identified barriers to BRCA and HRD/HRRm testing for management of oncology patients. The findings of this study provide guidance for future research and strategies to increase the adoption and improve use of BRCA and HRD/HRRm testing.