PERCEPTIONS OF MOLECULAR BIOMARKER TESTING IN CANCER DIAGNOSIS AMONG ONCOLOGY CLINICIANS
DOI:
https://doi.org/10.71000/9qnm8h14Keywords:
Attitude of Health Personnel, Biomarkers, , Cancer Diagnosis, Health Services Accessibility, Molecular Diagnostic Techniques, Oncology, Pakistan, Precision Medicine, Qualitative Research, WorkflowAbstract
Background: Molecular biomarker testing has become a cornerstone of precision oncology, guiding targeted therapy and improving diagnostic accuracy. However, its integration into routine cancer care, particularly in low- and middle-income countries, remains suboptimal due to multifactorial challenges.
Objective: To explore the experiences, attitudes, and perceived barriers faced by oncology clinicians in implementing molecular biomarker testing in routine cancer care in Lahore, Pakistan.
Methods: A qualitative descriptive study was conducted over eight months in Lahore, utilizing purposive sampling to recruit 23 oncology clinicians from public and private tertiary care hospitals. Semi-structured, in-depth interviews were audio-recorded, transcribed, and analyzed using Braun and Clarke’s thematic analysis framework. Data saturation was achieved and NVivo software supported systematic coding.
Results: Five major themes emerged: clinical relevance and awareness, operational and logistical challenges, educational and training gaps, ethical and emotional dilemmas, and systemic and policy-driven barriers. Clinicians reported variability in biomarker knowledge, difficulties in interpreting results, infrastructure limitations, and lack of standardized protocols. Emotional strain in discussing ambiguous or unactionable results, and disparities in patient access due to financial constraints, were also prominent. Participants emphasized the need for clearer guidelines, institutional support, and continued medical education.
Conclusion: The study highlights the complex landscape surrounding biomarker testing adoption in oncology practice within a resource-limited setting. Addressing the identified barriers through systemic reform, clinician support, and targeted education can enhance the practical uptake of precision diagnostics, ultimately improving cancer care delivery in similar contexts.
References
Pollack A, Karrison TG, Balogh AG, Gomella LG, Low DA, Bruner DW, et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial. Lancet. 2022;399(10338):1886-901.
Uno H, Horiguchi M. Biomarkers in Oncology: Complexities in Biomarker-Driven Studies and Statistical Analysis. JCO Precis Oncol. 2024;8:e2400358.
Normanno N, Apostolidis K, De Lorenzo F, Beer P, Henderson R, Sullivan R, et al. Cancer Biomarkers in the era of precision oncology: Addressing the needs of patients and health systems. Seminars in cancer biology. 2021.
Passaro A, Al Bakir M, Hamilton EG, Diehn M, André F, Roy-Chowdhuri S, et al. Cancer biomarkers: Emerging trends and clinical implications for personalized treatment. Cell. 2024;187(7):1617-35.
Jiang T, Nam DH, Ram Z, Poon WS, Wang J, Boldbaatar D, et al. Clinical practice guidelines for the management of adult diffuse gliomas. Cancer Lett. 2021;499:60-72.
Martin N, Shivakumar L, Boehmer L, Lile A, Cohen S, Pixley A, et al. Defining key care events to integrate biomarker testing in the workup for patients with advanced non–small cell lung cancer (aNSCLC). Journal of Clinical Oncology. 2022.
Kushnyr V. DEVELOPMENT OF A DIAGNOSTIC TEST SYSTEM FOR CANCER DIAGNOSTICS AND ITS IMPACT ON MEDICINE. Věda a perspektivy. 2024.
Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma. Virchows Arch. 2021;478(2):153-90.
Castellanos E, Orlando A, Xinran, Parikh R, O'Connell G, Meropol N, et al. Evaluating the Impact of Oncology Care Model Reporting Requirements on Biomarker Testing and Treatment. JCO Oncology Practice. 2020;16.
Subbiah V, Gouda MA, Ryll B, Burris HA, 3rd, Kurzrock R. The evolving landscape of tissue-agnostic therapies in precision oncology. CA Cancer J Clin. 2024;74(5):433-52.
De Jager V, Timens W, Bayle A, Botling J, Brčić L, Büttner R, et al. Future perspective for the application of predictive biomarker testing in advanced stage non-small cell lung cancer. The Lancet Regional Health - Europe. 2024;38.
Rodríguez N, Viñal D, Rodríguez-Cobos J, De Castro J, Domínguez G. Genomic profiling in oncology clinical practice. Clin Transl Oncol. 2020;22(9):1430-9.
Brewer I, Kettle J, Johnson A, Vosuri V, Tuncer T, Papageorgiou C. Impact of establishing a precision oncology program at a rural academic cancer center on cancer care delivery. Journal of Clinical Oncology. 2022.
Huelsman K, Offit C, Waugh W, McNair C, Kurtin S, Enstad C, et al. Integrating electronic health records (EHRs) to facilitate cancer biomarker testing: Real-world implementation barriers and solutions. Journal of Clinical Oncology. 2024.
Imyanitov E, Sokolenko A. Integrative Genomic Tests in Clinical Oncology. Int J Mol Sci. 2022;23(21).
Nataren N, Yamada M, Prow T. Molecular Skin Cancer Diagnosis: Promise and Limitations. J Mol Diagn. 2023;25(1):17-35.
Lee SG. Molecular Target and Action Mechanism of Anti-Cancer Agents. Int J Mol Sci. 2023;24(9).
Samsom K, Bosch L, Schipper L, Schout D, Roepman P, Boelens M, et al. Optimized whole-genome sequencing workflow for tumor diagnostics in routine pathology practice. Nature protocols. 2023.
Tang X, Berger MF, Solit DB. Precision oncology: current and future platforms for treatment selection. Trends Cancer. 2024;10(9):781-91.
Gong D, Arbesfeld-Qiu JM, Perrault E, Bae JW, Hwang WL. Spatial oncology: Translating contextual biology to the clinic. Cancer Cell. 2024;42(10):1653-75.
Gan Q, Roy-Chowdhuri S. Specimen Considerations in Molecular Oncology Testing. Clin Lab Med. 2022;42(3):367-83.
Lin YM, Taiji R, Calandri M, Odisio BC. Tumor Biomarkers and Interventional Oncology: Impact on Local Outcomes for Liver and Lung Malignancy. Curr Oncol Rep. 2021;23(6):67.
Whiteside TL, Diergaarde B, Hong CS. Tumor-Derived Exosomes (TEX) and Their Role in Immuno-Oncology. Int J Mol Sci. 2021;22(12).
Smith A, Ang IL, Acharya R, Moore T, DeFeo S, O'Brien C, et al. “What you're hearing from all of us is simplify the language”: A focus group study on biomarker testing in oncology. Journal of Clinical Oncology. 2024.
Colomer R, Mondéjar R, Romero-Laorden N, Alfranca A, Sánchez‐Madrid F, Quintela-Fandino M. When should we order a next generation sequencing test in a patient with cancer? EClinicalMedicine. 2020;25.
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Copyright (c) 2025 Ariba Shah, Hafsa Hameed Thakur, Amna Noor, Nighat Fatima, Irfan Ishaque, Aeman Mumtaz (Author)
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