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Aisner DL, Gocke CD, Jones D, Limson M, Morrissette J, Segal JP. The Genomics Organization for Academic Laboratories (GOAL): A vision for a genomics future for academic pathology. Acad Pathol 2023; 10:100090. [PMID: 37583476 PMCID: PMC10424130 DOI: 10.1016/j.acpath.2023.100090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/26/2023] [Accepted: 06/18/2023] [Indexed: 08/17/2023] Open
Abstract
Innovative and self-sustaining clinical genomics laboratories specializing in cutting-edge oncology testing are critical to the success of academic pathology departments and resident and fellow education in molecular pathology. However, the pressures and challenges facing these laboratories are numerous, including the complexities of validating comprehensive cancer next-generation sequencing (NGS) panels, competition from commercial laboratories, and the reimbursement and regulatory hurdles inherent in high-complexity testing. Cross-institutional collaborations, including shared assay content and interpretative frameworks, are a valuable element to academic laboratory success. To address these and other needs, the Genomics Organization for Academic Laboratories (GOAL) was conceived in 2018, incorporated in 2020 and has grown to include 29 participating institutions in 2022. Here, we describe the mission of GOAL, its structure, and the outcomes and projects undertaken in its first years.
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Affiliation(s)
- Dara L. Aisner
- Department of Pathology, University of Colorado, Denver, CO, USA
| | | | - Daniel Jones
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Melvin Limson
- Genomics Organization for Academic Laboratories and the Association of Pathology Chairs, Wilmington, DE, USA
| | - Jennifer Morrissette
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy P. Segal
- Department of Pathology, University of Chicago, Chicago, IL, USA
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Darling KW, Kohut M, Leeds S, Anderson EC, Han PK. "Doing Good" in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology. NEW GENETICS AND SOCIETY 2022; 41:254-283. [PMID: 36589528 PMCID: PMC9799983 DOI: 10.1080/14636778.2022.2091532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/30/2022] [Indexed: 06/17/2023]
Abstract
Genomic Tumour Testing (GTT) is an emerging site of "experimental care" in oncology [Cambrosio, Alberto, Peter Keating, Etienne Vignola-Gagné, Sylvain Besle, and Pascale Bourret. 2018a. "Extending Experimentation: Oncology's Fading Boundary Bbetween Research and Care." New Genetics and Society 37 (3): 207-226. doi: 10.1080/14636778.2018.1487281]. Few efforts to implement GTT have reached community oncology practices or patients living in rural communities within the US. Drawing on interdisciplinary research on a state-wide cancer genomics initiative in the rural US state of Maine, this paper explores the valuation practices within community oncologist and cancer stakeholders accounts of "doing good" within genomic science and care. We contribute to STS literatures on the bio-economy by highlighting the affective dimensions of strategies for managing economic and non-economic values. Clinician and stakeholders negotiated de-economizing and capitalizing modes of doing good as they built local genomic platforms "for Maine." These situated modes of doing good and feeling good via cancer genomics shaped how they navigated the ethical ambiguities of US biomedical markets across the boundaries of research and care.
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Affiliation(s)
| | - Michael Kohut
- Center for Interdisciplinary Public & Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - Susan Leeds
- Center for Interdisciplinary Public & Health Research, MaineHealth Institute for Research, Portland, ME, USA
| | - Eric C. Anderson
- Center for Interdisciplinary Public & Health Research, MaineHealth Institute for Research, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Paul K.J. Han
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
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Besle S, Sarradon-Eck A. Chronicity and the patient's decision-making work. The case of an advanced cancer patient. Anthropol Med 2022; 29:76-91. [PMID: 35306943 DOI: 10.1080/13648470.2022.2041546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This paper focuses on the particular situation of an advanced cancer patient whose condition has taken a chronic turn. We argue that chronicity of this kind sometimes falls at the frontier of Evidence Based Medicine because the uncertainty about the patient's condition can lead physicians to resort to clinical trials or non-licensed drugs to prevent the disease from progressing. This situation leaves plenty of scope for individual adjustments between patients and their doctors. Advanced cancer is regarded here not just as a biological event but as a chronic illness and a 'negotiated reality'. We argue that the chronicity of advanced cancer patients' situation broadens the patients' scope for 'work', and we have called this specific type of patient's work 'decision-making work'. This paper is based on a case study focusing on Patrick, a middle-aged Frenchman with metastatic lung cancer who underwent oncological treatment for seven years and was strongly determined to find new therapeutic options even if this meant having to go abroad. He actively orchestrated his therapeutic itinerary by reorganising his relationships with the medical world and coordinating the physicians' work. His particular social position enabled Patrick to bypass some of the current medical rules and to reorganise the usual pattern of distribution of medical responsibilities. The chronicity of his condition placed him at the very frontier of the health care system.
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Affiliation(s)
- Sylvain Besle
- Universite Claude Bernard Lyon, Villeurbanne, France.,Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Aline Sarradon-Eck
- SESSTIM UMR 1252, CANBIOS, Marseille, France.,Paoli-Calmettes Institute, Marseille, France
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Dam MS, Green S, Bogicevic I, Hillersdal L, Spanggaard I, Rohrberg KS, Svendsen MN. Precision patients: Selection practices and moral pathfinding in experimental oncology. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:345-359. [PMID: 34993996 DOI: 10.1111/1467-9566.13424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
This paper addresses selection practices in a Danish phase 1 unit specialised in precision medicine in the field of oncology. Where precision medicine holds the ambition of selecting genetically fit medicine for the patient, we find that precision medicine in the early trial setting is oriented towards selecting clinically and genetically fit patients for available treatment protocols. Investigating how phase 1 oncologists experience and respond to the moral challenges of selecting patients for early clinical trials, we show that inclusion criteria and patient categories are not always transparent to patients. Lack of transparency about inclusion criteria has been interpreted as morally problematic. Yet drawing on social science studies of 'unknowing', we argue that silence and non-transparency in interactions between oncologists and patients are crucial to respect the moral agency of patients at the edge of life and recognise them as belonging to the public of Danish health care. In the discussion, we consider the practice of placing 'unfit' patients on a waiting list for trial participation. Rather than representing an ethical and political problem, we argue, the waiting list can act as a valve enabling oncologists to navigate the scientific and as well as the moral uncertainties in phase 1 oncology.
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Affiliation(s)
- Mie S Dam
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sara Green
- Centre for Medical Science and Technology Studies, Department of Science Education, University of Copenhagen, Copenhagen, Denmark
| | - Ivana Bogicevic
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Line Hillersdal
- Centre for Medical Science and Technology Studies, Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Iben Spanggaard
- The Phase I Unit, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | - Mette N Svendsen
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Greco C, Arteaga I, Fabian-Therond C, Llewellyn H, Swallow J, Viney W. Cancer, COVID-19, and the need for critique. Wellcome Open Res 2021; 5:280. [PMID: 33521331 PMCID: PMC7839273 DOI: 10.12688/wellcomeopenres.16404.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 12/05/2022] Open
Abstract
In this open letter we examine the implications of the coronavirus disease 2019 (COVID-19) pandemic for cancer research and care from the point of view of the social studies of science, technology, and medicine. We discuss how the pandemic has disrupted several aspects of cancer care, underscoring the fragmentation of institutional arrangements, the malleable priorities in cancer research, and the changing promises of therapeutic innovation. We argue for the critical relevance of qualitative social sciences in cancer research during the pandemic despite the difficulties of immersive kinds of fieldwork. Social science research can help understand the ongoing, situated and lived impact of the pandemic, as well as fully underline its socially stratified consequences. We outline the risk that limiting and prioritising research activities according to their immediate clinical outcomes might have in the relational and longitudinal understanding of cancer practices in the UK. Finally, we alert against potential distortions that a "covidization" of cancer research might entail, arguing for the need to maintain a critical point of view on the pandemic.
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Affiliation(s)
- Cinzia Greco
- Centre for the History of Science Technology and Medicine (CHSTM), University of Manchester, Manchester, M13 9PL, UK
| | - Ignacia Arteaga
- Department of Social Anthropology, University of Cambridge, Cambridge, CB2 3RF, UK
| | | | - Henry Llewellyn
- UCL Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Julia Swallow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - William Viney
- Department of Anthropology, Goldsmiths, University of London, London, SE14 6NW, UK
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Bogicevic I, Svendsen MN. Taming Time: Configuring Cancer Patients as Research Subjects. Med Anthropol Q 2021; 35:386-401. [PMID: 33866608 DOI: 10.1111/maq.12647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
This article explores how incurable cancer patients in the affluent Danish welfare state are recruited to clinical trials. We show that patients' impending death constitutes their potential for being configured as research subjects. To produce valuable data, patients who enroll in trials and health care professionals must engage in daily "time practices" that prolong the threshold between life and death. When death becomes inevitable, the limit of configuring dying cancer patients as research subjects is reached. Navigating this temporal logic, health care professionals balance the boundary between patients' instrumental worth as research subjects and their intrinsic worth as dying cancer patients. Whereas previous studies have critically uncovered how clinical trials operate at socioeconomic margins, we point to the ways in which clinical trials operate through temporal margins. We argue that clinical trials are dependent on configuring marginal societal spaces and marginal bodies from which to produce knowledge.
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Greco C, Arteaga I, Fabian-Therond C, Llewellyn H, Swallow J, Viney W. Cancer, COVID-19, and the need for critique. Wellcome Open Res 2020; 5:280. [PMID: 33521331 PMCID: PMC7839273 DOI: 10.12688/wellcomeopenres.16404.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 09/21/2023] Open
Abstract
In this open letter we examine the implications of the coronavirus disease 2019 (COVID-19) pandemic for cancer research and care from the point of view of the social studies of science, technology, and medicine. We discuss how the pandemic has disrupted several aspects of cancer care, underscoring the fragmentation of institutional arrangements, the malleable priorities in cancer research, and the changing promises of therapeutic innovation. We argue for the critical relevance of qualitative social sciences in cancer research during the pandemic despite the difficulties of immersive kinds of fieldwork. Social science research can help understand the ongoing, situated and lived impact of the pandemic, as well as fully underline its socially stratified consequences. We outline the risk that limiting and prioritising research activities according to their immediate clinical outcomes might have in the relational and longitudinal understanding of cancer practices in the UK. Finally, we alert against potential distortions that a "covidization" of cancer research might entail, arguing for the need to maintain a critical point of view on the pandemic.
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Affiliation(s)
- Cinzia Greco
- Centre for the History of Science Technology and Medicine (CHSTM), University of Manchester, Manchester, M13 9PL, UK
| | - Ignacia Arteaga
- Department of Social Anthropology, University of Cambridge, Cambridge, CB2 3RF, UK
| | | | - Henry Llewellyn
- UCL Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Julia Swallow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9LD, UK
| | - William Viney
- Department of Anthropology, Goldsmiths, University of London, London, SE14 6NW, UK
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