Medical oncologists' perspectives of the Veterans Affairs National Precision Oncology Program

PLoS One. 2020 Jul 24;15(7):e0235861. doi: 10.1371/journal.pone.0235861. eCollection 2020.


Background: To support the rising need for testing and to standardize tumor DNA sequencing practices within the U.S. Department of Veterans Affairs (VA)'s Veterans Health Administration (VHA), the National Precision Oncology Program (NPOP) was launched in 2016. We sought to assess oncologists' practices, concerns, and perceptions regarding Next-Generation Sequencing (NGS) and the NPOP.

Materials and methods: Using a purposive total sampling approach, oncologists who had previously ordered NGS for at least one tumor sample through the NPOP were invited to participate in semi-structured interviews. Questions assessed the following: expectations for the NPOP, procedural requirements, applicability of testing results, and the summative utility of the NPOP. Interviews were assessed using an open coding approach. Thematic analysis was conducted to evaluate the completed codebook. Themes were defined deductively by reviewing the direct responses to interview questions as well as inductively by identifying emerging patterns of data.

Results: Of the 105 medical oncologists who were invited to participate, 20 (19%) were interviewed from 19 different VA medical centers in 14 states. Five recurrent themes were observed: (1) Educational Efforts Regarding Tumor DNA Sequencing Should be Undertaken, (2) Pathology Departments Share a Critical Role in Facilitating Test Completion, (3) Tumor DNA Sequencing via NGS Serves as the Most Comprehensive Testing Modality within Precision Oncology, (4) The Availability of the NPOP Has Expanded Options for Select Patients, and (5) The Completion of Tumor DNA Sequencing through the NPOP Could Help Improve Research Efforts within VHA Oncology Practices.

Conclusion: Medical oncologists believe that the availability of tumor DNA sequencing through the NPOP could potentially lead to an improvement in outcomes for veterans with metastatic solid tumors. Efforts should be directed toward improving oncologists' understanding of sequencing, strengthening collaborative relationships between oncologists and pathologists, and assessing the role of comprehensive NGS panels within the battery of precision tests.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Early Detection of Cancer / standards
  • Female
  • Genetic Testing / standards
  • Health Knowledge, Attitudes, Practice*
  • High-Throughput Nucleotide Sequencing / standards*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / diagnosis
  • Neoplasms / genetics*
  • Oncologists / psychology*
  • Precision Medicine / standards
  • Sequence Analysis, DNA / standards*
  • State Health Plans
  • Surveys and Questionnaires
  • United States
  • United States Department of Veterans Affairs*

Grants and funding

An affiliation with a funder, IBM Watson Health, was shared among a few of our authors. The funder provided support in the form of salaries for authors [JLS, VM, DW, GPJ], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funder also provided support in the form of previous salary to one author (HGS) and consultative fees for one author (VLP). The specific roles of these authors are articulated in the ‘author contributions’ section. For the purposes of this study, the funder did provide support in the form of research materials.