Abstract：
OBJECTIVE: Patients with dihydropyrimidine dehydrogenase (DPD) deficiency are at high risk for severe and fatal toxicity from fluoropyrimidine (FP) chemotherapy. Pre-treatment DPYD testing is standard of care in many countries, but not the United States (US). This survey assessed pre-treatment DPYD testing approaches in the US to identify best practices for broader adoption.
METHODS: From August to October 2023, a 22-item QualtricsXM survey was sent to institutions and clinicians known to conduct pre-treatment DPYD testing and broadly distributed through relevant organizations and social networks. Responses were analyzed using descriptive analysis.
RESULTS: Responses from 24 unique US sites that have implemented pre-treatment DPYD testing or have a detailed implementation plan in place were analyzed. Only 33% of sites ordered DPYD testing for all FP-treated patients; at the remaining sites, patients were tested depending on disease characteristics or clinician preference. Almost 50% of sites depend on individual clinicians to remember to order testing without the assistance of electronic alerts or workflow reminders. DPYD testing was most often conducted by commercial laboratories that tested for at least the four or five DPYD variants considered clinically actionable. Approximately 90% of sites reported receiving results within 10 days of ordering.
CONCLUSIONS: Implementing DPYD testing into routine clinical practice is feasible and requires a coordinated effort among the healthcare team. These results will be used to develop best practices for the clinical adoption of DPYD testing to prevent severe and fatal toxicity in cancer patients receiving FP chemotherapy.
METHODS: From August to October 2023, a 22-item QualtricsXM survey was sent to institutions and clinicians known to conduct pre-treatment DPYD testing and broadly distributed through relevant organizations and social networks. Responses were analyzed using descriptive analysis.
RESULTS: Responses from 24 unique US sites that have implemented pre-treatment DPYD testing or have a detailed implementation plan in place were analyzed. Only 33% of sites ordered DPYD testing for all FP-treated patients; at the remaining sites, patients were tested depending on disease characteristics or clinician preference. Almost 50% of sites depend on individual clinicians to remember to order testing without the assistance of electronic alerts or workflow reminders. DPYD testing was most often conducted by commercial laboratories that tested for at least the four or five DPYD variants considered clinically actionable. Approximately 90% of sites reported receiving results within 10 days of ordering.
CONCLUSIONS: Implementing DPYD testing into routine clinical practice is feasible and requires a coordinated effort among the healthcare team. These results will be used to develop best practices for the clinical adoption of DPYD testing to prevent severe and fatal toxicity in cancer patients receiving FP chemotherapy.
摘要：
目的：二氢嘧啶脱氢酶（DPD）缺乏症患者氟嘧啶（FP）化疗产生严重和致命毒性的风险很高。治疗前DPYD测试是许多国家的护理标准，但不是美国（US）。这项调查评估了美国治疗前DPYD测试方法，以确定更广泛采用的最佳实践。
方法：从2023年8月至10月，向已知进行治疗前DPYD测试的机构和临床医生发送了22项QualtricsXM调查，并通过相关组织和社交网络广泛分发。使用描述性分析对回答进行分析。
结果：分析了来自24个独特的美国站点的反应，这些站点已实施了治疗前DPYD测试或有详细的实施计划。只有33%的网站要求对所有FP治疗的患者进行DPYD测试；在其余网站，根据疾病特征或临床医生的偏好对患者进行检测.几乎50％的网站依赖于个别临床医生记得在没有电子警报或工作流程提醒的帮助下订购测试。DPYD测试最常由商业实验室进行,其测试被认为临床上可行的至少四种或五种DPYD变体。大约90％的网站报告在订购后10天内收到结果。
结论：在常规临床实践中实施DPYD检测是可行的，需要医疗团队的协调努力。这些结果将用于开发临床采用DPYD测试的最佳实践，以预防接受FP化疗的癌症患者的严重和致命毒性。
方法：从2023年8月至10月，向已知进行治疗前DPYD测试的机构和临床医生发送了22项QualtricsXM调查，并通过相关组织和社交网络广泛分发。使用描述性分析对回答进行分析。
结果：分析了来自24个独特的美国站点的反应，这些站点已实施了治疗前DPYD测试或有详细的实施计划。只有33%的网站要求对所有FP治疗的患者进行DPYD测试；在其余网站，根据疾病特征或临床医生的偏好对患者进行检测.几乎50％的网站依赖于个别临床医生记得在没有电子警报或工作流程提醒的帮助下订购测试。DPYD测试最常由商业实验室进行,其测试被认为临床上可行的至少四种或五种DPYD变体。大约90％的网站报告在订购后10天内收到结果。
结论：在常规临床实践中实施DPYD检测是可行的，需要医疗团队的协调努力。这些结果将用于开发临床采用DPYD测试的最佳实践，以预防接受FP化疗的癌症患者的严重和致命毒性。
